Healthcare Provider Details

I. General information

NPI: 1013706936
Provider Name (Legal Business Name): OMEGA MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W WALKER AVE
TEMPLE TX
76501-1740
US

IV. Provider business mailing address

5900 BALCONES DR
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 254-677-8874
  • Fax: 254-677-8874
Mailing address:
  • Phone: 512-318-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNA SAMON LOSOYA
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 254-677-8874