Organization
LIFE REVISE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE PALACIOS LPC-S (OWNER)
(817) 821-3690
Entity
Organization
Contact information
Practice address
2321 S BELT LINE RD STE 117, GRAND PRAIRIE, TX 75051-4181
(817) 821-3690
Mailing address
2824 PARK PLACE DR, GRAND PRAIRIE, TX 75052-8521
(817) 821-3690
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
64640
TX
Other
Enumeration date
12/18/2014
Last updated
12/18/2014
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