| Inner Revolution, Pllc | |
|
603 S Main St Ste 209 Grapevine TX 76051-5387 | |
| (903) 399-5131 | |
| Not Available |
| Full Name | Inner Revolution, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 603 S Main St Ste 209, Grapevine, Texas |
| Authorized Official Name and Position | Jamie English (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9033995131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Revolution, Pllc 925 S Main St Unit 3161 Grapevine TX 76051-7555 Ph: (903) 399-5131 | Inner Revolution, Pllc 603 S Main St Ste 209 Grapevine TX 76051-5387 Ph: (903) 399-5131 |
| NPI Number | 1275242703 |
|---|---|
| Provider Enumeration Date | 11/23/2022 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275242703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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