MEDICARE: MINDFUL PLAY PSYCHOLOGICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1780526327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL PLAY PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	11145 TAMPA AVE STE 12B
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11145 TAMPA AVE STE 12B
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2215
Country	:	US
Telephone Number	:	818-336-1644
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AURIELLE MASON
Credential	:	PSY.D.
Telephone Number	:	818-336-1644

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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