Provider Demographics
NPI:1679864318
Name:HOMESTEAD HOPE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HOMESTEAD HOPE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, BCPCC
Authorized Official - Phone:817-812-3021
Mailing Address - Street 1:2701 WEST BERRY STREET
Mailing Address - Street 2:SUITE 133
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-812-3021
Mailing Address - Fax:817-812-3035
Practice Address - Street 1:2701 WEST BERRY STREET
Practice Address - Street 2:SUITE 133
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-812-3021
Practice Address - Fax:817-812-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65237101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty