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General NPI Number Information
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NPI Number | 1558853960
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Entity Type | Organization
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Legal Business Name | RECOVERING CHRISTIANITY, INC.
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 550 BAILEY AVE STE 235
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City | FORT WORTH
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State | TX
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Zip | 76107-2100
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Country | US
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Telephone | 817-291-1987
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Fax | 817-886-8489
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Provider Business Mailing Address
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Address Line | 550 BAILEY AVE STE 235
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City | FORT WORTH
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State | TX
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Zip | 76107-2100
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Country | US
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Telephone | 817-291-1987
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Fax |
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Authorized Official
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Title or Position | VP - COUNSELOR
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Name | CHRIS GROFF
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Credential | LPC
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Telephone | 682-385-9258
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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 | 75067
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License Number State | TX
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