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General NPI Number Information
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NPI Number | 1083500615
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Entity Type | Organization
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Legal Business Name | EMBER & TIDE ORCHARD COLLECTIVE, LLC
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1998 INDUSTRIAL BLVD STE C
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City | ABILENE
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State | TX
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Zip | 79602-7848
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Country | US
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Telephone | 325-266-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 707 HILLTOP ST
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City | BAIRD
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State | TX
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Zip | 79504-2355
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Country | US
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Telephone | 817-235-2949
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | RACHEL CISNEROZ BRACKETT
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Credential | LPC
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Telephone | 817-235-2949
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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 |
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License Number State |
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