MEDICARE: MR. JONATHAN ERNEST HARDY M.S.W.

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	26364	TX

General Provider Information

NPI Number	:	1174858641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN ERNEST HARDY M.S.W.

Provider Business Mailing Address
First Line	:	1610 DOE PARK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-2016
Country	:	US
Telephone Number	:	210-875-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	11107 WURZBACH RD
Second Line	:	SUITE 604
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2500
Country	:	US
Telephone Number	:	210-875-8874
Fax Number	:

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

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	10/16/2009

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