Individual
MR. DERICK JEROME HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASTERS
Contact information
Practice address
1202 KIRKMAN ST STE A, LAKE CHARLES, LA 70601-5391
(337) 419-3586
Mailing address
6027 CANDICE LN, LAKE CHARLES, LA 70615-4773
(337) 404-1721
(337) 434-2333
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1889253
—
LA
Enumeration date
02/10/2016
Last updated
05/11/2022
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