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General NPI Number Information
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NPI Number | 1821337056
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Entity Type | Organization
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Legal Business Name | RESILIENCE COUNSELING LLC
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1161 SW WILSHIRE BLVD SUITE 136
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City | BURLESON
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State | TX
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Zip | 76028-5707
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Country | US
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Telephone | 817-426-5051
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Fax | 817-420-4307
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Provider Business Mailing Address
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Address Line | 1161 SW WILSHIRE BLVD SUITE 136
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City | BURLESON
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State | TX
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Zip | 76028-5707
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Country | US
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Telephone | 817-426-5051
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Fax | 817-420-4307
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. ROBERT CLARK JR.
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Credential | MA LPC
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Telephone | 817-426-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 66476
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License Number State | TX
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