Provider Demographics
NPI:1184842866
Name:HARDY, BETTIE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTIE
Middle Name:W
Last Name:HARDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2919
Mailing Address - Country:US
Mailing Address - Phone:214-526-3675
Mailing Address - Fax:
Practice Address - Street 1:5646 MILTON ST
Practice Address - Street 2:SUITE 412
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-3907
Practice Address - Country:US
Practice Address - Phone:214-526-3675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22552103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist