Provider Demographics
NPI:1861998668
Name:HARDT, CHELSEA (MA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:HARDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CHERRY RIDGE ST STE B205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4825
Mailing Address - Country:US
Mailing Address - Phone:210-685-2266
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST STE B205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4825
Practice Address - Country:US
Practice Address - Phone:210-685-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-29570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-29570OtherBOARD CERTIFIED BEHAVIOR ANALYST
14229367OtherCAQH