Provider Demographics
NPI:1689978405
Name:HARGRAVE, LEONARD BRUCE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:BRUCE
Last Name:HARGRAVE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-0020
Mailing Address - Country:US
Mailing Address - Phone:903-217-5977
Mailing Address - Fax:430-542-1660
Practice Address - Street 1:8480 E RIDGE DR
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-6235
Practice Address - Country:US
Practice Address - Phone:903-217-5977
Practice Address - Fax:305-421-6604
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2179285Medicaid