MEDICARE: JODI HARDY LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LPC-16122	AZ
2	101YP2500X	Professional Counselor	LPC-16122	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YP2500X	OTHER	AZ	NA

General Provider Information

NPI Number	:	1205382694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI HARDY LPC

Provider Business Mailing Address
First Line	:	3861 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-209-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3861 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-209-1755
Fax Number	:

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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Directions to “ JODI HARDY LPC” Practice Location

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