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NPI Code Detail

MEDICARE: UPTOWN TRAUMA AND RELATIONSHIP COUNSELING PLLC

MEDICARE: UPTOWN TRAUMA AND RELATIONSHIP COUNSELING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1033740345
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPTOWN TRAUMA AND RELATIONSHIP COUNSELING PLLC
Provider Business Mailing Address
First Line : 100 CRESCENT CT STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75201-2112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 CRESCENT CT STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75201-2112
Country : US
Telephone Number : 817-223-0077
Fax Number :
Authorized Official
Title or Position : THERAPIST/OWNER
Name : AUBREE RALEY
Credential : LPC
Telephone Number : 817-223-0077
Provider Enumeration Date : 01/27/2020
Last Update Date : 01/27/2020

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