Provider Demographics
NPI:1053673301
Name:HARGROVE, JIMMY DON (MFTI)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DON
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34538 DOUBLE DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-4107
Mailing Address - Country:US
Mailing Address - Phone:760-702-1715
Mailing Address - Fax:
Practice Address - Street 1:72710 E LYNN ST
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-3312
Practice Address - Country:US
Practice Address - Phone:760-343-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist