Provider Demographics
NPI:1619403466
Name:KRENCIK, MARK ALLAN (LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:KRENCIK
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAPLE ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8303
Mailing Address - Country:US
Mailing Address - Phone:940-440-6053
Mailing Address - Fax:
Practice Address - Street 1:405 N MCDONALD ST STE B
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3911
Practice Address - Country:US
Practice Address - Phone:972-542-4144
Practice Address - Fax:972-542-4154
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25374101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)