Healthcare Provider Details

I. General information

NPI: 1891261202
Provider Name (Legal Business Name): TOSHA MONYETTE OWENS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOSHA M OWENS-ERVIN

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date: 07/30/2023
Reactivation Date: 09/11/2023

III. Provider practice location address

4422 AVENIDA DE LA CARLOTA, SUITE 190
LAGUNA HILLS CA
92653
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 190
LAGUNA HILLS CA
92653-3634
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone: 800-801-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: