Provider Demographics
NPI:1679632046
Name:THARP, GREGORY J (PH D)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:THARP
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKE FRONT CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3613
Mailing Address - Country:US
Mailing Address - Phone:281-705-3410
Mailing Address - Fax:
Practice Address - Street 1:1600 LAKE FRONT CIR STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3613
Practice Address - Country:US
Practice Address - Phone:281-705-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024NNOtherBLUE CROSS / BLUE SHEILD
TX00D98RMedicare PIN