| Innovative Trauma Therapy, Pllc | |
|
220 N Park Blvd Ste 112 Grapevine TX 76051-6900 | |
| (817) 330-9730 | |
| Not Available |
| Full Name | Innovative Trauma Therapy, Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 220 N Park Blvd Ste 112, Grapevine, Texas |
| Authorized Official Name and Position | Ashley Cook Rovira (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9033636516 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Trauma Therapy, Pllc 220 N Park Blvd Ste 112 Grapevine TX 76051-6900 Ph: (817) 330-9730 | Innovative Trauma Therapy, Pllc 220 N Park Blvd Ste 112 Grapevine TX 76051-6900 Ph: (817) 330-9730 |
| NPI Number | 1679354971 |
|---|---|
| Provider Enumeration Date | 10/12/2023 |
| Last Update Date | 10/12/2023 |
| Certification Date | 10/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679354971 | NPI | - | NPPES |
| 1891042255 | Medicaid | TX | |
| 1568739563 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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