Provider Demographics
NPI:1013785443
Name:REKINDLED HOPE, PLLC
Entity Type:Organization
Organization Name:REKINDLED HOPE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-466-1696
Mailing Address - Street 1:702 JOHNSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2820
Mailing Address - Country:US
Mailing Address - Phone:432-466-7696
Mailing Address - Fax:
Practice Address - Street 1:702 JOHNSON ST STE 104
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2820
Practice Address - Country:US
Practice Address - Phone:432-466-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty