# INNOVATIVE TRAUMA THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679354971
- **Authorized official:** MS. ASHLEY COOK ROVIRA M.S. (OWNER/PSYCHOTHERAPIST)
- **Authorized official phone:** (903) 363-6516

## Contact information

- **Practice address:** 220 N PARK BLVD STE 112, GRAPEVINE, TX 76051-6900
- **Practice address phone:** (817) 330-9730
- **Mailing address:** 220 N PARK BLVD STE 112, GRAPEVINE, TX 76051-6900
- **Mailing address phone:** (817) 330-9730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2023
- **Last updated:** 10/12/2023