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General NPI Number Information
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NPI Number | 1902585912
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Entity Type | Organization
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Legal Business Name | REVIVE AND RESTORE COUNSELING, PLLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 5030 HUFFINES BLVD
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City | ROYSE CITY
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State | TX
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Zip | 75189-2443
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Country | US
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Telephone | 972-834-5449
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Fax |
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Provider Business Mailing Address
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Address Line | 5030 HUFFINES BLVD
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City | ROYSE CITY
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State | TX
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Zip | 75189-2443
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Country | US
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Telephone | 972-834-5449
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Fax |
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Authorized Official
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Title or Position | LMFT, OWNER
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Name | GLORIA DUKES
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Credential | MA
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Telephone | 469-740-5832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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