Provider Demographics
NPI:1326139619
Name:HARGROVE, DEBRA D (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:HARGROVE
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 1:202 W BEAUREGARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5884
Mailing Address - Country:US
Mailing Address - Phone:325-655-8472
Mailing Address - Fax:325-658-4727
Practice Address - Street 1:202 W BEAUREGARD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5884
Practice Address - Country:US
Practice Address - Phone:325-655-8472
Practice Address - Fax:325-658-4727
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12339101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
124967OtherMHN
124967OtherMHN