Provider Demographics
NPI:1124106372
Name:HART, MANDY NICHOLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:NICHOLE
Last Name:HART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2301-95
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-9218
Mailing Address - Country:US
Mailing Address - Phone:512-431-4558
Mailing Address - Fax:512-777-2982
Practice Address - Street 1:358 BLUE RIVER PKWY UNIT E-95
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498-5558
Practice Address - Country:US
Practice Address - Phone:512-431-4558
Practice Address - Fax:512-777-2982
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health