Provider Demographics
NPI:1386231553
Name:HARDY, DANA L (LMSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:HARDY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5593 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1336
Mailing Address - Country:US
Mailing Address - Phone:208-322-5354
Mailing Address - Fax:208-322-5379
Practice Address - Street 1:5593 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1336
Practice Address - Country:US
Practice Address - Phone:208-322-5354
Practice Address - Fax:208-322-5379
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health