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NPI Code Detail

MEDICARE: MR. DONALD ELLIS HARDY-HOLLEY LPC

MEDICARE: MR. DONALD ELLIS HARDY-HOLLEY LPC
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
1101YM0800XMental Health Counselor08824TX
2106H00000XMarriage & Family Therapist1913TX

General Provider Information

NPI Number : 1588900153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD ELLIS HARDY-HOLLEY LPC
Provider Business Mailing Address
First Line : PO BOX 690414
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78269-0414
Country : US
Telephone Number : 210-690-4144
Fax Number : 210-690-1020
Provider Business Practice Location Address
First Line : 4939 DEZAVALA RD STE 104
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2001
Country : US
Telephone Number : 210-690-4144
Fax Number : 210-690-1020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2012
Last Update Date : 12/29/2012

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