Provider Demographics
NPI:1588900153
Name:HARDY-HOLLEY, DONALD ELLIS (LPC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ELLIS
Last Name:HARDY-HOLLEY
Suffix:
Gender:M
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 690414
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0414
Mailing Address - Country:US
Mailing Address - Phone:210-690-4144
Mailing Address - Fax:210-690-1020
Practice Address - Street 1:4939 DEZAVALA RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2001
Practice Address - Country:US
Practice Address - Phone:210-690-4144
Practice Address - Fax:210-690-1020
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08824101YM0800X
TX1913106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist