Individual
MS. REBECCA HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
1257 EAST CENTER STREET, POCATELLO, ID 83201-1257
(208) 904-1583
(208) 904-1583
Mailing address
P.O. BOX 4841, POCATELLO, ID 83205-4841
(208) 904-1573
(208) 904-1583
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
40
ME
1041C0700X
Clinical Social Worker
Primary
32114
ID
1041C0700X
Clinical Social Worker
666
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005062
VALUE OPTIONS
—
01
—
010826
ANTHEM
ME
01
—
1036664
CIGNA
—
01
—
5722229
AETNA
—
Enumeration date
11/22/2006
Last updated
05/02/2016
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