Healthcare Provider Details

I. General information

NPI: 1235854266
Provider Name (Legal Business Name): TYLER HUDSON HARDY MPH,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 12/04/2022
Certification Date: 12/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 E COLFAX AVE
DENVER CO
80206-1507
US

IV. Provider business mailing address

2822 E COLFAX AVE
DENVER CO
80206-1507
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-2299
  • Fax:
Mailing address:
  • Phone: 303-563-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAADC
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-22-1923
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: