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General NPI Number Information
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NPI Number | 1013706936
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Entity Type | Organization
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Legal Business Name | OMEGA MENTAL WELLNESS
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 310 W WALKER AVE
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City | TEMPLE
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State | TX
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Zip | 76501-1740
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Country | US
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Telephone | 254-677-8874
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Fax | 254-677-8874
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 512-318-2199
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. SHANNA SAMON LOSOYA
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Credential | PMHNP-BC
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Telephone | 254-677-8874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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