Provider Demographics
NPI:1487200960
Name:HARDY, KIMBERLY LYNN (LPC-ASSOCIATE, LCDC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:HARDY
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 5TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-4622
Mailing Address - Country:US
Mailing Address - Phone:409-202-9010
Mailing Address - Fax:
Practice Address - Street 1:211 W 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-4622
Practice Address - Country:US
Practice Address - Phone:940-202-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14972101YA0400X
TX92274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)