Provider Demographics
NPI:1720891518
Name:MCR MIND AND BODY WELLNESS LLC
Entity type:Organization
Organization Name:MCR MIND AND BODY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICCARDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-207-3903
Mailing Address - Street 1:5616 GROVE COVE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8333
Mailing Address - Country:US
Mailing Address - Phone:469-207-3903
Mailing Address - Fax:
Practice Address - Street 1:5616 GROVE COVE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8333
Practice Address - Country:US
Practice Address - Phone:469-207-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty