Healthcare Provider Details

I. General information

NPI: 1932829041
Provider Name (Legal Business Name): SERENECO WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 10/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 AVON LN STE 190B
FRISCO TX
75033-1549
US

IV. Provider business mailing address

4645 AVON LN STE 190B
FRISCO TX
75033-1549
US

V. Phone/Fax

Practice location:
  • Phone: 972-259-0109
  • Fax:
Mailing address:
  • Phone: 972-259-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AARON KRZYCKI
Title or Position: OWNER
Credential:
Phone: 972-259-0109