Healthcare Provider Details

I. General information

NPI: 1922675644
Provider Name (Legal Business Name): MOOD CLINICAL, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 W 17TH ST STE C
SANTA ANA CA
92706-3554
US

IV. Provider business mailing address

PO BOX 52456
PHOENIX AZ
85072-2456
US

V. Phone/Fax

Practice location:
  • Phone: 619-639-9730
  • Fax: 619-374-1359
Mailing address:
  • Phone: 619-639-9730
  • Fax: 619-374-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONALD HUGH MAYES
Title or Position: PRESIDENT
Credential:
Phone: 702-882-8415