Provider Demographics
NPI:1245531227
Name:THARP, MARY MORGAN (MED)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MORGAN
Last Name:THARP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:THARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S
Mailing Address - Street 1:212 N CHRISMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2730
Mailing Address - Country:US
Mailing Address - Phone:662-400-3009
Mailing Address - Fax:
Practice Address - Street 1:212 N CHRISMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2730
Practice Address - Country:US
Practice Address - Phone:662-400-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health