Provider Demographics
NPI:1558190405
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:
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:469-441-6163
Mailing Address - Fax:
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:817-618-6001
Practice Address - Fax:469-405-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No283Q00000XHospitalsPsychiatric Hospital