Provider Demographics
NPI:1629835087
Name:MB WELLNESS ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MB WELLNESS ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:OTENG-MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:972-951-0698
Mailing Address - Street 1:1651 N COLLINS BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3683
Mailing Address - Country:US
Mailing Address - Phone:972-951-0698
Mailing Address - Fax:
Practice Address - Street 1:1651 N COLLINS BLVD STE 224
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3683
Practice Address - Country:US
Practice Address - Phone:972-951-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health