Individual provider Active NPI

Mandy Fine, LPC, LCDC

  • Mental Health Counselor
  • Frisco, TX
National Provider Identifier
1356914501
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
85855 Issued in TX
Practice address
4645 Avon LN Ste 190B
Frisco, TX 75033-1549
Phone
(972) 259-0109
NPI assigned
Jul 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 15474 TX
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 85855 TX Primary

Addresses

Primary practice location

4645 Avon LN Ste 190B
Frisco, TX 75033-1549

Mailing address

4645 Avon LN Ste 190B
Frisco, TX 75033-1549
Phone (972) 259-0109

Other practice location 1

506 N Main St
Bonham, TX 75418-3718
Phone (903) 710-1994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
15474TXMDAddiction (Substance Use Disorder) Counselor
85855TXMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sereneco Wellness Center LLC Mental Health CurrentSince Sep 4, 2022 Accepting new patients
Sereneco Wellness Multi-Specialty CurrentSince Jul 25, 2021 Accepting new patients

Locations

506 N Main St
Bonham, TX 75418
Phone (903) 710-1994

4645 Avon Ln
Ste 190B
Frisco, TX 75033
Phone (972) 259-0109

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1356914501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 AVON LN STE 190B",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750331549",
            "telephone_number": "972-259-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 AVON LN STE 190B",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750331549",
            "telephone_number": "972-259-0109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 N Main St",
            "address_purpose": "LOCATION",
            "city": "Bonham",
            "state": "TX",
            "postal_code": "754183718",
            "country_code": "US",
            "telephone_number": "903-710-1994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FINE",
        "first_name": "MANDY",
        "credential": "LPC, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-23",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "15474",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "85855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.