Provider Demographics
NPI:1467930107
Name:HARDY, SIOHBON D (MA, LPC, CMCP)
Entity Type:Individual
Prefix:
First Name:SIOHBON
Middle Name:D
Last Name:HARDY
Suffix:
Gender:F
Credentials:MA, LPC, CMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 E 44TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3435
Mailing Address - Country:US
Mailing Address - Phone:312-523-6449
Mailing Address - Fax:
Practice Address - Street 1:542 E 44TH ST APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3435
Practice Address - Country:US
Practice Address - Phone:312-523-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty