Provider Demographics
NPI:1275075632
Name:HARDY, PETE
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369126
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-9126
Mailing Address - Country:US
Mailing Address - Phone:773-870-6513
Mailing Address - Fax:
Practice Address - Street 1:10725 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3135
Practice Address - Country:US
Practice Address - Phone:773-870-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00108205OtherCERTIFIED REHABILITATION COUNSELOR
IL178005894OtherLICENSED PROFESSIONAL COUNSELOR
IL25274OtherCERTIFIED ALCOHOL AND DRUG COUNSELOR
IL180.010966OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR