Provider Demographics
NPI:1073900437
Name:VITALITY PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:VITALITY PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTORF
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:972-841-9509
Mailing Address - Street 1:6675 MEDITERRANEAN DR
Mailing Address - Street 2:SUITE #506
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5573
Mailing Address - Country:US
Mailing Address - Phone:972-841-9509
Mailing Address - Fax:
Practice Address - Street 1:6675 MEDITERRANEAN DR
Practice Address - Street 2:#506
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5573
Practice Address - Country:US
Practice Address - Phone:972-841-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty