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General NPI Number Information
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NPI Number | 1164846853
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Entity Type | Organization
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Legal Business Name | AGAPE' COUNSELING CLINIC, LLC
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Dates
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Enumeration Date | 02/15/2014
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Last Update Date | 02/15/2014
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Provider Practice Location Address
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Address Line | 5613 WILLOWBROOK DR
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City | ROWLETT
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State | TX
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Zip | 75088-7663
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Country | US
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Telephone | 214-213-7138
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Fax | 972-463-9714
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Provider Business Mailing Address
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Address Line | 5613 WILLOWBROOK DR
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City | ROWLETT
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State | TX
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Zip | 75088-7663
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Country | US
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Telephone | 214-213-7138
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Fax | 972-463-9714
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | DR. LEONARD BRUCE HARGRAVE
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Credential | LMFT-S; NCAC II
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Telephone | 214-213-7138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2802
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License Number State | TX
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