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General NPI Number Information
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NPI Number | 1689978405
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Entity Type | Individual
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Provider Name | LEONARD BRUCE HARGRAVE L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 8480 E RIDGE DR
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City | QUINLAN
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State | TX
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Zip | 75474-6235
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Country | US
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Telephone | 903-217-5977
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Fax | 305-421-6604
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Provider Business Mailing Address
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Address Line | PO BOX 1149
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City | QUINLAN
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State | TX
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Zip | 75474-0020
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Country | US
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Telephone | 903-217-5977
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Fax | 430-542-1660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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