Provider Demographics
NPI:1477675171
Name:HARDY, MED, CARLA L (LMFT,LPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:HARDY, MED
Suffix:
Gender:F
Credentials:LMFT,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N BAY BREEZE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3849
Mailing Address - Country:US
Mailing Address - Phone:832-794-1621
Mailing Address - Fax:
Practice Address - Street 1:12300 FORD RD STE 190
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-8111
Practice Address - Country:US
Practice Address - Phone:832-794-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6082101YP2500X
TX1841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841OtherLMFT
1940OtherNBCCHYPNOSIS
TX6082OtherLPC