=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356783542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTFELT CHRISTIAN COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2013
-----------------------------------------------------
Last Update Date | 07/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4702 ROWLETT RD SUITE 101
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-996-2242
-----------------------------------------------------
Fax | 972-996-2245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 299
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75030-0299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-996-2242
-----------------------------------------------------
Fax | 972-996-2245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MR. THOMAS ROSS HAMMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-996-2242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 65581
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------