Provider Demographics
NPI:1821337056
Name:RESILIENCE COUNSELING LLC
Entity Type:Organization
Organization Name:RESILIENCE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:817-426-5051
Mailing Address - Street 1:1161 SW WILSHIRE BLVD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5707
Mailing Address - Country:US
Mailing Address - Phone:817-426-5051
Mailing Address - Fax:817-420-4307
Practice Address - Street 1:1161 SW WILSHIRE BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5707
Practice Address - Country:US
Practice Address - Phone:817-426-5051
Practice Address - Fax:817-420-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherDEPARTMENT OF TREASURY