Provider Demographics
NPI:1982951919
Name:HARGROVES, EDWARD III (M ED, BCBA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HARGROVES
Suffix:III
Gender:M
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N. JOSEY LANE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3159
Mailing Address - Country:US
Mailing Address - Phone:469-892-7500
Mailing Address - Fax:469-575-3002
Practice Address - Street 1:3630 N JOSEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3159
Practice Address - Country:US
Practice Address - Phone:469-892-7500
Practice Address - Fax:469-575-3002
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-11-8499103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-11-8499OtherBCBA LICENSE NUMBER