Basic Information
| Provider Information | |||||||||
| NPI: | 1144330234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | MA LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2708 HUNT RD | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172632150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33101 ANNAPOLIS SUITE B | ||||||||
| Address2: | HEGIRA PROGRAMS INC | ||||||||
| City: | WAYNE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347210200 | ||||||||
| FaxNumber: | 7347212008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401008910 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.