Healthcare Provider Details

I. General information

NPI: 1285486936
Provider Name (Legal Business Name): THE MINDCOUNSEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 TEMESCAL CANYON RD STE 401
CORONA CA
92883-4626
US

IV. Provider business mailing address

2701 SANTA FIORA DR
CORONA CA
92882-1113
US

V. Phone/Fax

Practice location:
  • Phone: 909-263-8000
  • Fax: 909-265-9433
Mailing address:
  • Phone: 909-263-8000
  • Fax: 909-265-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD REYES CASILANG
Title or Position: PRESIDENT
Credential: DNP, PMHNP-BC
Phone: 833-559-9559