Healthcare Provider Details

I. General information

NPI: 1881925477
Provider Name (Legal Business Name): NICHELLE M HARDY MA, MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CRAIG RD STE 105
SAINT LOUIS MO
63146-4758
US

IV. Provider business mailing address

1810 CRAIG RD STE 105
SAINT LOUIS MO
63146-4758
US

V. Phone/Fax

Practice location:
  • Phone: 314-409-1259
  • Fax: 314-392-9898
Mailing address:
  • Phone: 314-409-1259
  • Fax: 314-392-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008036329
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: