Provider Demographics
NPI:1073219770
Name:MONICA RENEA GRAY ENTERPRISES LLC
Entity Type:Organization
Organization Name:MONICA RENEA GRAY ENTERPRISES LLC
Other - Org Name:LIFE INTENSITY COUNSELING & CASE MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-441-6163
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0856
Mailing Address - Country:US
Mailing Address - Phone:817-618-6001
Mailing Address - Fax:
Practice Address - Street 1:4411 EMERALD LEAF DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5545
Practice Address - Country:US
Practice Address - Phone:469-708-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1N093OtherMEDICARE
TX331022909Medicaid