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General NPI Number Information
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NPI Number | 1912860214
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Entity Type | Organization
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Legal Business Name | REVIVED BY GRACE COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 8325 BROADWAY ST. STE 202
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 512-318-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IYESHA GATLING
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Credential | LMFT
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Telephone | 646-379-0450
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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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