MEDICARE: GREGORY J THARP PH. D

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	103TC0700X	Clinical Psychologist	23499	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024NN	OTHER	TX	BLUE CROSS / BLUE SHEILD

General Provider Information

NPI Number	:	1679632046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J THARP PH. D

Provider Business Mailing Address
First Line	:	1600 LAKE FRONT CIR STE 150
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3613
Country	:	US
Telephone Number	:	281-705-3410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 LAKE FRONT CIR STE 150
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3613
Country	:	US
Telephone Number	:	281-705-3410
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	05/12/2009

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