Provider Demographics
NPI:1457521114
Name:HARDCASTLE, ALTAN C (LCSW)
Entity Type:Individual
Prefix:
First Name:ALTAN
Middle Name:C
Last Name:HARDCASTLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 KURTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3556
Mailing Address - Country:US
Mailing Address - Phone:208-852-6385
Mailing Address - Fax:
Practice Address - Street 1:732 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3748
Practice Address - Country:US
Practice Address - Phone:208-852-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-287001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical