Provider Demographics
NPI:1871166934
Name:HARDEE, CHRISTY GAYLE (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:GAYLE
Last Name:HARDEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 COOPER SQUARE CIR APT 130
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5147
Mailing Address - Country:US
Mailing Address - Phone:817-696-1785
Mailing Address - Fax:
Practice Address - Street 1:1171 107TH ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2502
Practice Address - Country:US
Practice Address - Phone:817-649-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-17
Last Update Date:2021-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11846752OtherDRIVER LICENSE