Provider Demographics
NPI:1710354477
Name:HARGROVE, AMBER ELISSA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELISSA
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 ADDISON RD STE 305
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16415 ADDISON RD STE 305
Practice Address - Street 2:SUITE 305
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3218
Practice Address - Country:US
Practice Address - Phone:817-501-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional