MEDICARE: PMI WELLNESS GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1992542112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMI WELLNESS GROUP PLLC

Provider Business Mailing Address
First Line	:	1525 US HIGHWAY 380 STE 500 #331
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-0176
Country	:	US
Telephone Number	:	214-469-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	14605 PRAIRIE FIRE DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-7028
Country	:	US
Telephone Number	:	214-469-4213
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. PATRICK IYKE IGBOKWE
Credential	:
Telephone Number	:	214-469-4213

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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