MEDICARE: MR. ROBERT ALVIN HARDEE LCPC

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	101YM0800X	Mental Health Counselor	LCPC-7334	ID

General Provider Information

NPI Number	:	1669778379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ALVIN HARDEE LCPC

Provider Business Mailing Address
First Line	:	11360 S GREENBRIER DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7768
Country	:	US
Telephone Number	:	702-533-5613
Fax Number	:	702-538-8452

Provider Business Practice Location Address
First Line	:	84 ELKS PEAK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5200
Country	:	US
Telephone Number	:	702-533-5613
Fax Number	:	702-538-8452

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

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	04/05/2023

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