Provider Demographics
NPI:1841818879
Name:SERENECO WELLNESS
Entity type:Organization
Organization Name:SERENECO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:972-832-9199
Mailing Address - Street 1:4645 AVON LN STE 190B
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1549
Mailing Address - Country:US
Mailing Address - Phone:972-259-0109
Mailing Address - Fax:469-777-3812
Practice Address - Street 1:4645 AVON LN STE 190B
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1549
Practice Address - Country:US
Practice Address - Phone:972-259-0109
Practice Address - Fax:469-777-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty