MEDICARE: REKINDLED HOPE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1013785443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REKINDLED HOPE, PLLC

Provider Business Mailing Address
First Line	:	702 JOHNSON ST STE 104
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-2820
Country	:	US
Telephone Number	:	432-466-7696
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 JOHNSON ST STE 104
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-2820
Country	:	US
Telephone Number	:	432-466-7696
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/OWNER
Name	:	JAN SHAW
Credential	:	LPC
Telephone Number	:	432-466-1696

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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