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General NPI Number Information
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NPI Number | 1396610275
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Entity Type | Organization
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Legal Business Name | THE WELLNESS VINEYARD
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1402 S CUSTER RD STE 903
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City | MCKINNEY
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State | TX
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Zip | 75072-1455
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Country | US
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Telephone | 469-269-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N PRESTON RD STE 50-173
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City | PROSPER
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State | TX
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Zip | 75078-8786
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Country | US
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Telephone | 469-269-0791
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CHANDA R MCGHEE
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Credential | PH.D.
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Telephone | 469-269-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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