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General NPI Number Information
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NPI Number | 1679354971
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Entity Type | Organization
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Legal Business Name | INNOVATIVE TRAUMA THERAPY, PLLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 220 N PARK BLVD STE 112
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City | GRAPEVINE
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State | TX
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Zip | 76051-6900
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Country | US
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Telephone | 817-330-9730
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Fax |
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Provider Business Mailing Address
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Address Line | 220 N PARK BLVD STE 112
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City | GRAPEVINE
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State | TX
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Zip | 76051-6900
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Country | US
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Telephone | 817-330-9730
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. ASHLEY COOK ROVIRA
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Credential | M.S.
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Telephone | 903-363-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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