Provider Demographics
NPI:1194028662
Name:HARDY, NICHOLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13806 SANDSTONE BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1612
Mailing Address - Country:US
Mailing Address - Phone:901-550-9585
Mailing Address - Fax:
Practice Address - Street 1:13806 SANDSTONE BRIDGE LANE
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-1612
Practice Address - Country:US
Practice Address - Phone:713-609-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical