MEDICARE: MR. RUSS HARDISON M.A.

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	LH00007994	WA

General Provider Information

NPI Number	:	1265543649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSS HARDISON M.A.

Provider Business Mailing Address
First Line	:	2592 KWINA RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-9278
Country	:	US
Telephone Number	:	360-384-0464
Fax Number	:	360-384-2336

Provider Business Practice Location Address
First Line	:	2665 KWINA RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-9291
Country	:	US
Telephone Number	:	360-312-2115
Fax Number	:	360-380-6976

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/20/2014

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