=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487200960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY LYNN HARDY LPC, LCDC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2019
-----------------------------------------------------
Last Update Date | 07/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 W 5TH ST
-----------------------------------------------------
City | JUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76247-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-202-9017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9201 HIDDEN POND ST
-----------------------------------------------------
City | JUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76247-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-689-9406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 14972
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 92274
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------