Provider Demographics
NPI:1154645760
Name:HIS FULLNESS MINISTRIES, INC.
Entity Type:Organization
Organization Name:HIS FULLNESS MINISTRIES, INC.
Other - Org Name:HFM COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRESCA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GRANNUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LPC-S
Authorized Official - Phone:512-986-4872
Mailing Address - Street 1:921 WEST NEW HOPE DRIVE
Mailing Address - Street 2:SUITE 704
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-986-4872
Mailing Address - Fax:
Practice Address - Street 1:921 W NEW HOPE DR
Practice Address - Street 2:SUITE 704
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6784
Practice Address - Country:US
Practice Address - Phone:512-986-4872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63896251S00000X
TX41155251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health