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General NPI Number Information
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NPI Number | 1679648638
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Entity Type | Individual
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Provider Name | REBECCA HARDY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 1257 EAST CENTER STREET
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City | POCATELLO
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State | ID
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Zip | 83201-1257
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Country | US
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Telephone | 208-904-1583
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Fax | 208-904-1583
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Provider Business Mailing Address
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Address Line | P.O. BOX 4841
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City | POCATELLO
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State | ID
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Zip | 83205-4841
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Country | US
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Telephone | 208-904-1573
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Fax | 208-904-1583
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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 | 40
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 666
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 32114
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License Number State | ID
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