MEDICARE: MRS. SHARON ANNE HARGRAVE M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4459	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4459	OTHER	TX	LMFT

General Provider Information

NPI Number	:	1437273232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON ANNE HARGRAVE M.A.

Provider Business Mailing Address
First Line	:	6902 ELMHURST RD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-2823
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

Provider Business Practice Location Address
First Line	:	4211 W INTERSTATE 40
Second Line	:	SUITE 203
City	:	AMARILLO
State	:	TX
Zip	:	79106-6053
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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