Healthcare Provider Details

I. General information

NPI: 1407763501
Provider Name (Legal Business Name): NEUROSOMA MENTAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SIMI VILLAGE DR # 940224
SIMI VALLEY CA
93065-7426
US

IV. Provider business mailing address

225 SIMI VILLAGE DR # 940224
SIMI VALLEY CA
93065-7426
US

V. Phone/Fax

Practice location:
  • Phone: 805-539-7838
  • Fax:
Mailing address:
  • Phone: 805-539-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHICONIA C ANDERSON
Title or Position: OWNER/CEO
Credential: LMFT
Phone: 805-539-7838