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General NPI Number Information
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NPI Number | 1649087396
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Entity Type | Individual
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Provider Name | TIKO S HARDY LAC, LCSW, PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1257 LAKE PLAZA DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3553
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Country | US
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Telephone | 719-424-4653
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Fax | 719-579-9094
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Provider Business Mailing Address
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Address Line | 1257 LAKE PLAZA DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3553
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Country | US
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Telephone | 719-424-4653
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Fax | 719-579-9094
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0001423
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0009920399
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License Number State | CO
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