Provider Demographics
NPI:1922583483
Name:HOPE FOR HOME COUNSELING
Entity Type:Organization
Organization Name:HOPE FOR HOME COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRYD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-667-3515
Mailing Address - Street 1:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-2020
Mailing Address - Country:US
Mailing Address - Phone:469-667-3515
Mailing Address - Fax:
Practice Address - Street 1:162 N. DALLAS AVE
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-7549
Practice Address - Country:US
Practice Address - Phone:469-667-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)