Provider Demographics
NPI:1407155419
Name:VITRA COUNSELING ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:VITRA COUNSELING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ALISIA
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-293-5294
Mailing Address - Street 1:2736 DENALI PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1309
Mailing Address - Country:US
Mailing Address - Phone:214-293-5294
Mailing Address - Fax:972-606-1044
Practice Address - Street 1:2736 DENALI PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1309
Practice Address - Country:US
Practice Address - Phone:214-293-5294
Practice Address - Fax:972-606-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty