Provider Demographics
NPI:1053418756
Name:THARP, DAVID FAY (PSYD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FAY
Last Name:THARP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 INDEPENDENCE TRL
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-9603
Mailing Address - Country:US
Mailing Address - Phone:979-219-2160
Mailing Address - Fax:
Practice Address - Street 1:39 INDEPENDENCE TRL
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-9603
Practice Address - Country:US
Practice Address - Phone:979-219-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical