Healthcare Provider Details

I. General information

NPI: 1316891708
Provider Name (Legal Business Name): ROOTS OF THE MIND MARRIAGE & FAMILY THERAPY, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W ORANGEWOOD AVE STE 105
ORANGE CA
92868-5052
US

IV. Provider business mailing address

2835 PARK VISTA CT
FULLERTON CA
92835-2910
US

V. Phone/Fax

Practice location:
  • Phone: 714-987-1906
  • Fax: 714-386-7323
Mailing address:
  • Phone: 714-987-1906
  • Fax: 714-386-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AUDRIANA MARIE GREGORIO
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 714-987-1906