Provider Demographics
NPI:1932256484
Name:MCTAGUE, SYLVIA HURST (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:HURST
Last Name:MCTAGUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:SYLVIA
Other - Middle Name:LENORE
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6900 INTERSTATE 40 WEST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2529
Mailing Address - Country:US
Mailing Address - Phone:806-359-5697
Mailing Address - Fax:806-354-8680
Practice Address - Street 1:6900 INTERSTATE 40 WEST
Practice Address - Street 2:SUITE 210
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2529
Practice Address - Country:US
Practice Address - Phone:806-359-5697
Practice Address - Fax:806-354-8680
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX936101YM0800X
TX979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
189624OtherVALUE OPTIONS
TX2161LCOtherBLUE CROSS BLUE SHIELD OF