Provider Demographics
NPI:1164846853
Name:AGAPE' COUNSELING CLINIC, LLC
Entity Type:Organization
Organization Name:AGAPE' COUNSELING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-S; NCAC II
Authorized Official - Phone:214-213-7138
Mailing Address - Street 1:5613 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-7663
Mailing Address - Country:US
Mailing Address - Phone:214-213-7138
Mailing Address - Fax:972-463-9714
Practice Address - Street 1:5613 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-7663
Practice Address - Country:US
Practice Address - Phone:214-213-7138
Practice Address - Fax:972-463-9714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAPE' COUNSELING CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty