Provider Demographics
NPI:1326026907
Name:HARKLEROAD, MARY M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:HARKLEROAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682749
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-2749
Mailing Address - Country:US
Mailing Address - Phone:615-807-4020
Mailing Address - Fax:615-807-4022
Practice Address - Street 1:2014 QUAIL HOLLOW CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5967
Practice Address - Country:US
Practice Address - Phone:615-807-4020
Practice Address - Fax:615-807-4022
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW10201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN260017491OtherRAILROAD MEDICARE
TN144470OtherBCBS
TN3693131Medicaid
TN144470OtherBCBS