Provider Demographics
NPI:1467699652
Name:ANDREA HARBAUGH LPC PA
Entity Type:Organization
Organization Name:ANDREA HARBAUGH LPC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:817-735-4165
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-735-4165
Mailing Address - Fax:817-735-4688
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:SUITE 602
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-735-4165
Practice Address - Fax:817-735-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146244201Medicaid