Provider Demographics
NPI:1386183184
Name:HARDESTY, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 S CONTINENTAL DIVIDE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4253
Mailing Address - Country:US
Mailing Address - Phone:303-704-8361
Mailing Address - Fax:
Practice Address - Street 1:8420 S CONTINENTAL DIVIDE RD
Practice Address - Street 2:STE 220
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4253
Practice Address - Country:US
Practice Address - Phone:303-704-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health