Provider Demographics
NPI:1497838643
Name:CARTER-HARGROVE, INC
Entity Type:Organization
Organization Name:CARTER-HARGROVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARCHIE
Authorized Official - Last Name:CARTER-HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-771-1010
Mailing Address - Street 1:924 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4442
Mailing Address - Country:US
Mailing Address - Phone:775-771-1010
Mailing Address - Fax:
Practice Address - Street 1:1001 PYRAMID WAY
Practice Address - Street 2:STE 402
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4494
Practice Address - Country:US
Practice Address - Phone:775-771-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0258261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002616058Medicaid
NVPHD258Medicare ID - Type UnspecifiedPSYCHOLOGIST