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General NPI Number Information
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NPI Number | 1588900153
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Entity Type | Individual
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Provider Name | DONALD ELLIS HARDY-HOLLEY LPC
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Gender | Male
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Dates
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Enumeration Date | 12/29/2012
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Last Update Date | 12/29/2012
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Provider Practice Location Address
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Address Line | 4939 DEZAVALA RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2001
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Country | US
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Telephone | 210-690-4144
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Fax | 210-690-1020
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Provider Business Mailing Address
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Address Line | PO BOX 690414
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City | SAN ANTONIO
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State | TX
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Zip | 78269-0414
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Country | US
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Telephone | 210-690-4144
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Fax | 210-690-1020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 08824
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1913
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License Number State | TX
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