Denetra L Hardy, LPC

Individual provider Active NPI Professional Counselor · Glenwood, IL

NPI 1003483041 · NPPES record last updated Jul 12, 2021

Key facts

NPI
1003483041
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
178001961 (IL)
Practice address
302 S Willow St
Glenwood, IL 60425-1826
Phone
(708) 785-7810
NPI assigned
Jun 8, 2021
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
178001961ILMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178001961 IL Yes

Addresses

Primary practice location

302 S Willow St
Glenwood, IL 60425-1826

Mailing address

302 S Willow St
Glenwood, IL 60425-1826
Phone (708) 785-7810

Other providers in Glenwood, IL

All providers in Glenwood, IL · Professional Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.