MEDICARE: REBECCA HARDIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S41091	TX

General Provider Information

NPI Number	:	1003831215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HARDIN LCSW

Provider Business Mailing Address
First Line	:	4150 WESTHEIMER RD
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77027-4414
Country	:	US
Telephone Number	:	713-850-0049
Fax Number	:	713-850-0036

Provider Business Practice Location Address
First Line	:	4150 WESTHEIMER RD
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77027-4414
Country	:	US
Telephone Number	:	713-850-0049
Fax Number	:	713-850-0036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/25/2007

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