Healthcare Provider Details

I. General information

NPI: 1376230094
Provider Name (Legal Business Name): MOSAIC MENTAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 W CHAPMAN AVE STE 209
ORANGE CA
92868-2316
US

IV. Provider business mailing address

111 W HARRISON ST UNIT 205
CORONA CA
92878-4099
US

V. Phone/Fax

Practice location:
  • Phone: 714-340-7755
  • Fax: 714-922-8149
Mailing address:
  • Phone: 714-721-8388
  • Fax: 714-922-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN ASHLEY SHAPIRO
Title or Position: OWNER
Credential: PSYD
Phone: 714-721-8838