Provider Demographics
NPI:1902863996
Name:HARDSOCG, MARTIN L (MA, NCC, PC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:L
Last Name:HARDSOCG
Suffix:
Gender:M
Credentials:MA, NCC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:200 W 17TH ST
Practice Address - Street 2:SUITE 20
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4434
Practice Address - Country:US
Practice Address - Phone:307-637-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-166 LAT-142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311832OtherBLUE CROSS BLUE SHIELD