Provider Demographics
NPI:1275683161
Name:HARDY, REBECCA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:B
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 1:601 S MAIN ST
Mailing Address - Street 2:#210
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5382
Mailing Address - Country:US
Mailing Address - Phone:817-410-4748
Mailing Address - Fax:817-410-4749
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:#210
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5382
Practice Address - Country:US
Practice Address - Phone:817-410-4748
Practice Address - Fax:817-410-4749
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC14366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health