Provider Demographics
NPI:1548626070
Name:HARGROVE, STEFAN
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15502 WASHINGTON AVE SW APT B5
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-2071
Mailing Address - Country:US
Mailing Address - Phone:253-886-7961
Mailing Address - Fax:
Practice Address - Street 1:15502 WASHINGTON AVE SW APT B5
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-2071
Practice Address - Country:US
Practice Address - Phone:253-886-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor