MEDICARE: BEN E HARGROVE LPC, LMFT

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	101YP2500X	Professional Counselor	1104	TX
2	101YP2500X	Professional Counselor	4186	TX

General Provider Information

NPI Number	:	1477565802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN E HARGROVE LPC, LMFT

Provider Business Mailing Address
First Line	:	1715 STERLING CREEK CT
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3021
Country	:	US
Telephone Number	:	281-332-4273
Fax Number	:	281-332-4273

Provider Business Practice Location Address
First Line	:	1715 STERLING CREEK CT
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3021
Country	:	US
Telephone Number	:	281-332-4273
Fax Number	:	281-332-4273

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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