Provider Demographics
NPI:1760250203
Name:LIFE INTENSITY COUNSELING SERVICES
Entity type:Organization
Organization Name:LIFE INTENSITY COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
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 1:1201 FREESIA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4658
Mailing Address - Country:US
Mailing Address - Phone:817-618-6001
Mailing Address - Fax:469-405-6565
Practice Address - Street 1:9300 JOHN HICKMAN PKWY STE 801
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5913
Practice Address - Country:US
Practice Address - Phone:817-404-4492
Practice Address - Fax:469-405-6565
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:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No283Q00000XHospitalsPsychiatric Hospital
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children