Healthcare Provider Details

I. General information

NPI: 1962551812
Provider Name (Legal Business Name): BRUCE WAYNE HARDY PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 DUPONT CIR SUITE 379
LOUISVILLE KY
40207-4812
US

IV. Provider business mailing address

4010 DUPONT CIR SUITE 379
LOUISVILLE KY
40207-4812
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-9390
  • Fax: 502-895-1254
Mailing address:
  • Phone: 502-894-9390
  • Fax: 502-895-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0005
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0474
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: