Provider Demographics
NPI:1154096451
Name:THARP, GRAYSEN MARIE
Entity Type:Individual
Prefix:
First Name:GRAYSEN
Middle Name:MARIE
Last Name:THARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1216
Mailing Address - Country:US
Mailing Address - Phone:317-340-0741
Mailing Address - Fax:
Practice Address - Street 1:374 MERIDIAN PARKE LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9406
Practice Address - Country:US
Practice Address - Phone:317-889-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician