Healthcare Provider Details

I. General information

NPI: 1053263244
Provider Name (Legal Business Name): FLOURISH PSYCHOLOGY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25950 ACERO STE 360
MISSION VIEJO CA
92691-2781
US

IV. Provider business mailing address

27812 BERWICK
MISSION VIEJO CA
92691-7416
US

V. Phone/Fax

Practice location:
  • Phone: 949-426-9067
  • Fax:
Mailing address:
  • Phone: 949-796-9810
  • Fax: 949-796-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE ELIZABETH MANTEGNA
Title or Position: PSYCHOLOGIST
Credential: PSY.D
Phone: 949-796-9810