MEDICARE: GABRIELLE NICOLE HARDIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023692613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE NICOLE HARDIN

Provider Business Mailing Address
First Line	:	3420 S COTTAGE GROVE AVE APT 808
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5119
Country	:	US
Telephone Number	:	313-421-4496
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 S COTTAGE GROVE AVE APT 808
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5119
Country	:	US
Telephone Number	:	313-421-4496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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