Provider Demographics
NPI:1053431809
Name:REBUILDERS OF HOPE, INC
Entity type:Organization
Organization Name:REBUILDERS OF HOPE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:432-634-8509
Mailing Address - Street 1:PO BOX 80218
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-0218
Mailing Address - Country:US
Mailing Address - Phone:432-634-8509
Mailing Address - Fax:432-684-7671
Practice Address - Street 1:3000 N GARFIELD ST
Practice Address - Street 2:SUITE 245
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6400
Practice Address - Country:US
Practice Address - Phone:432-634-8509
Practice Address - Fax:432-684-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty