MEDICARE: TANNER DON HARGROVE

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	202371	TX

General Provider Information

NPI Number	:	1861986127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER DON HARGROVE

Provider Business Mailing Address
First Line	:	4211 W I 40 STE 101
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-6000
Country	:	US
Telephone Number	:	806-350-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 W I 40 STE 101
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-6000
Country	:	US
Telephone Number	:	806-350-5867
Fax Number	:

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

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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Directions to “ TANNER DON HARGROVE ” Practice Location

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