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General NPI Number Information
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NPI Number | 1245554443
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Entity Type | Organization
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Legal Business Name | REDEMPTIVE SOUL CARE--A MINISTRY OF REDEMPTION EVANGELICAL CHURCH
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 621 SW JOHNSON AVE SUITE C
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City | BURLESON
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State | TX
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Zip | 76028-5833
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Country | US
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Telephone | 817-426-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 621 SW JOHNSON AVE SUITE C
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City | BURLESON
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State | TX
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Zip | 76028-5833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHAD COOKE
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Credential | M.S., LPC
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Telephone | 817-426-8150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 19132
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License Number State | TX
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