Provider Demographics
NPI:1649561069
Name:HARDY, LASHAWN MONIQUE
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:MONIQUE
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 NW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6205
Mailing Address - Country:US
Mailing Address - Phone:405-590-1266
Mailing Address - Fax:
Practice Address - Street 1:3119 NW 39TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6205
Practice Address - Country:US
Practice Address - Phone:405-590-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health