Provider Demographics
NPI:1417070954
Name:HARDY, SARA CORA (LADC UNDER SUPERVISI)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:CORA
Last Name:HARDY
Suffix:
Gender:F
Credentials:LADC UNDER SUPERVISI
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:CORA
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC UNDER SUPERVISI
Mailing Address - Street 1:5319 S. LEWIS, STE 219
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-832-7763
Mailing Address - Fax:918-292-8250
Practice Address - Street 1:5319 S. LEWIS, STE 219
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105
Practice Address - Country:US
Practice Address - Phone:918-832-7763
Practice Address - Fax:918-292-8250
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)