Provider Demographics
NPI:1144330234
Name:HARDY, MICHAEL RAY (MA LLPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:HARDY
Suffix:
Gender:M
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-263-2150
Mailing Address - Fax:
Practice Address - Street 1:33101 ANNAPOLIS SUITE B
Practice Address - Street 2:HEGIRA PROGRAMS INC
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184
Practice Address - Country:US
Practice Address - Phone:734-721-0200
Practice Address - Fax:734-721-2008
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008910101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor