=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467699652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREA HARBAUGH LPC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2009
-----------------------------------------------------
Last Update Date | 01/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3840 HULEN ST SUITE 602
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-7277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-735-4165
-----------------------------------------------------
Fax | 817-735-4688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3840 HULEN ST SUITE 602
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-7277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-735-4165
-----------------------------------------------------
Fax | 817-735-4688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ANDREA D HARBAUGH
-----------------------------------------------------
Credential | MA LPC
-----------------------------------------------------
Telephone | 817-735-4165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 15280
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------