Healthcare Provider Details

I. General information

NPI: 1427372697
Provider Name (Legal Business Name): TRACEY YOUNG HARDY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WALDO ST SUITE C
ST AUGUSTINE FL
32084-2718
US

IV. Provider business mailing address

7 WALDO ST SUITE C
ST AUGUSTINE FL
32084-2718
US

V. Phone/Fax

Practice location:
  • Phone: 904-501-6921
  • Fax: 904-461-1650
Mailing address:
  • Phone: 904-501-6921
  • Fax: 904-461-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: