Provider Demographics
NPI:1376059592
Name:HARDIN, KALA (RBT)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SEVEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-6903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 COLLARD LN STE B
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-5800
Practice Address - Country:US
Practice Address - Phone:270-945-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2018-06-16
Deactivation Date:2017-12-26
Deactivation Code:
Reactivation Date:2018-01-10
Provider Licenses
StateLicense IDTaxonomies
KY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician