Provider Demographics
NPI:1619753787
Name:HARDY, KIMBERLY RASHELL (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RASHELL
Last Name:HARDY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14843 ENERGY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5757
Mailing Address - Country:US
Mailing Address - Phone:952-209-1644
Mailing Address - Fax:952-423-0365
Practice Address - Street 1:14843 ENERGY WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5757
Practice Address - Country:US
Practice Address - Phone:952-209-1644
Practice Address - Fax:952-423-0365
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health