Provider Demographics
NPI:1437273232
Name:HARGRAVE, SHARON ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANNE
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2823
Mailing Address - Country:US
Mailing Address - Phone:806-374-5950
Mailing Address - Fax:806-358-4345
Practice Address - Street 1:4211 W INTERSTATE 40
Practice Address - Street 2:SUITE 203
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6053
Practice Address - Country:US
Practice Address - Phone:806-374-5950
Practice Address - Fax:806-358-4345
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4459OtherLMFT