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General NPI Number Information
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NPI Number | 1053431809
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Entity Type | Organization
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Legal Business Name | REBUILDERS OF HOPE, INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 3000 N GARFIELD ST SUITE 245
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City | MIDLAND
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State | TX
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Zip | 79705-6400
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Country | US
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Telephone | 432-634-8509
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Fax | 432-684-7671
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Provider Business Mailing Address
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Address Line | PO BOX 80218
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City | MIDLAND
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State | TX
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Zip | 79708-0218
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Country | US
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Telephone | 432-634-8509
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Fax | 432-684-7671
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN B EDWARDS
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Credential | LPC, LCDC
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Telephone | 432-634-8509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19395
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License Number State | TX
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