Provider Demographics
NPI:1538231477
Name:VIOLA, ANNELL (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANNELL
Middle Name:
Last Name:VIOLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:NELLIE
Other - Middle Name:
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3900 GRAPEVINE MILLS PKWY
Mailing Address - Street 2:APT. #335
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1989
Mailing Address - Country:US
Mailing Address - Phone:214-226-4093
Mailing Address - Fax:972-304-0400
Practice Address - Street 1:413 W. BETHEL RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-393-1596
Practice Address - Fax:972-304-0400
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0045930Medicaid