=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134767890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVEAL AND RESTORE COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2019
-----------------------------------------------------
Last Update Date | 12/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 S STONEBRIDGE DR STE 1603
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-8104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-892-8335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9804 THOMAS JEFFERSON DR
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75072-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-892-8335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | TRINETTA POWELL
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 214-892-8335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------