Provider Demographics
NPI:1245554443
Name:REDEMPTIVE SOUL CARE--A MINISTRY OF REDEMPTION EVANGELICAL CHURCH
Entity type:Organization
Organization Name:REDEMPTIVE SOUL CARE--A MINISTRY OF REDEMPTION EVANGELICAL CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:817-426-8150
Mailing Address - Street 1:621 SW JOHNSON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 SW JOHNSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5833
Practice Address - Country:US
Practice Address - Phone:817-426-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19132251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health