Healthcare Provider Details

I. General information

NPI: 1144330234
Provider Name (Legal Business Name): MICHAEL RAY HARDY MA LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33101 ANNAPOLIS SUITE B HEGIRA PROGRAMS INC
WAYNE MI
48184
US

IV. Provider business mailing address

2708 HUNT RD
ADRIAN MI
49221
US

V. Phone/Fax

Practice location:
  • Phone: 734-721-0200
  • Fax: 734-721-2008
Mailing address:
  • Phone: 517-263-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401008910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: