=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679880827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STREAM OF HOPE COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 09/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 E MAIN ST
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-241-0513
-----------------------------------------------------
Fax | 210-561-5909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6147 SUNSET HVN
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-241-0513
-----------------------------------------------------
Fax | 210-561-5909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | ARISBEI HERNANDEZ
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 915-241-0513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 16318
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------