Provider Demographics
NPI:1518660943
Name:GRILLENBECK, RACHEL ANN (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:GRILLENBECK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 WESTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8833
Mailing Address - Country:US
Mailing Address - Phone:972-567-1358
Mailing Address - Fax:
Practice Address - Street 1:2404 ELLIS ST STE 4
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3392
Practice Address - Country:US
Practice Address - Phone:817-783-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78758101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor