Provider Demographics
NPI:1760250203
Name:LIFE INTENSITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:LIFE INTENSITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
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 1:4411 EMERALD LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5545
Mailing Address - Country:US
Mailing Address - Phone:817-618-6001
Mailing Address - Fax:469-405-6565
Practice Address - Street 1:2909 E ARKANSAS LN STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6930
Practice Address - Country:US
Practice Address - Phone:817-618-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE INTENSITY COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)