1326139619 NPI number — DEBRA D HARGROVE LCSW

Table of content: DEBRA D HARGROVE LCSW (NPI 1326139619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326139619 NPI number — DEBRA D HARGROVE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGROVE
Provider First Name:
DEBRA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326139619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 W BEAUREGARD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SAN ANGELO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76903-5884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-655-8472
Provider Business Mailing Address Fax Number:
325-658-4727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 W BEAUREGARD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN ANGELO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76903-5884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-655-8472
Provider Business Practice Location Address Fax Number:
325-658-4727
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  12339 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 12339 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124967 . This is a "MHN" identifier . This identifiers is of the category "OTHER".




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