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General NPI Number Information
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NPI Number | 1386961837
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Entity Type | Organization
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Legal Business Name | REGENESIS COUNSELING AND ASSESSMENT CENTER
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 906 W HENDERSON ST
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City | CLEBURNE
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State | TX
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Zip | 76033-4836
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Country | US
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Telephone | 817-264-6194
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Fax | 866-372-7985
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Provider Business Mailing Address
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Address Line | PO BOX 703
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City | KEENE
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State | TX
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Zip | 76059-0703
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Country | US
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Telephone | 817-714-6809
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KENNETH JONES
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Credential | LCSW
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Telephone | 817-714-6809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28460
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License Number State | TX
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