Provider Demographics
NPI:1235854266
Name:HARDY, TYLER HUDSON (MPH,)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:HUDSON
Last Name:HARDY
Suffix:
Gender:M
Credentials:MPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1507
Mailing Address - Country:US
Mailing Address - Phone:303-563-9569
Mailing Address - Fax:
Practice Address - Street 1:2822 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1507
Practice Address - Country:US
Practice Address - Phone:303-953-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAADC101YA0400X
ORT-22-1923101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22-QMHP-R-1674OtherQUALIFIED MENTAL HEALTH PROVIDER
ORT-22-1923OtherMENTAL HEALTH AND ADDICTION CERTIFICATION BOARD OF OREGON
COADDCOtherLICENSED ADDICTION COUNSELOR
TXLCDCOtherLICENSED CHEMICAL DEPENDENCY COUNSELOR
ORTG-22-095OtherCERTIFIED GAMBLING AND RECOVERY COUNSELOR