Provider Demographics
NPI:1902137656
Name:HARDJOLUKITO, TANTI APRIANTI (BCABA)
Entity Type:Individual
Prefix:
First Name:TANTI
Middle Name:APRIANTI
Last Name:HARDJOLUKITO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 CENTERVIEW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1318
Mailing Address - Country:US
Mailing Address - Phone:210-733-7440
Mailing Address - Fax:
Practice Address - Street 1:4502 CENTERVIEW
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1318
Practice Address - Country:US
Practice Address - Phone:210-733-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst