Provider Demographics
NPI:1972347193
Name:MYLYFE COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:MYLYFE COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:469-340-2887
Mailing Address - Street 1:2462 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-0048
Mailing Address - Country:US
Mailing Address - Phone:469-340-2887
Mailing Address - Fax:
Practice Address - Street 1:2379 GUS THOMASSON RD STE 300
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7102
Practice Address - Country:US
Practice Address - Phone:469-340-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty