Provider Demographics
NPI:1942728522
Name:HARDRICK, GREGORY NELSON III
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NELSON
Last Name:HARDRICK
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 E CRAIG RD APT 2285
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2529
Mailing Address - Country:US
Mailing Address - Phone:702-468-7474
Mailing Address - Fax:
Practice Address - Street 1:8430 W LAKE MEAD BLVD STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7672
Practice Address - Country:US
Practice Address - Phone:702-576-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty