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General NPI Number Information
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NPI Number | 1114892767
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Entity Type | Organization
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Legal Business Name | THE VINE MENTAL WELLNESS
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 24 GREENWAY PLZ STE 1800
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City | HOUSTON
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State | TX
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Zip | 77046-2457
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Country | US
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Telephone | 713-588-4479
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Fax |
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Provider Business Mailing Address
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Address Line | 24 GREENWAY PLZ STE 1800
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City | HOUSTON
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State | TX
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Zip | 77046-2457
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Country | US
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Telephone | 713-588-4479
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | DESIREE SHANTA MCDANIEL
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Credential | APRN
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Telephone | 713-588-4479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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