Basic Information
| Provider Information | |||||||||
| NPI: | 1770897241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER OF MCKINNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 VIRGINIA PARKWAY, | ||||||||
| Address2: | #834 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750715759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146433411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6404 INTERNATIONAL PKWY | ||||||||
| Address2: | 2100 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722671988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2010 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILLSON | ||||||||
| AuthorizedOfficialFirstName: | STELLA | ||||||||
| AuthorizedOfficialMiddleName: | INGRID | ||||||||
| AuthorizedOfficialTitleorPosition: | TREATMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9725485499 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 52462 | TX | Y | Agencies | Community/Behavioral Health |
No ID Information.