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General NPI Number Information
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NPI Number | 1053652057
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Entity Type | Organization
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Legal Business Name | MISSION OAKS COUNSELING AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 03/15/2013
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 1100 FLYNN RD SUITE 201
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City | CAMARILLO
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State | CA
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Zip | 93012-8737
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Country | US
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Telephone | 805-482-7724
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Fax | 805-618-6250
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Provider Business Mailing Address
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Address Line | 1100 FLYNN RD SUITE 201
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City | CAMARILLO
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State | CA
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Zip | 93012-8737
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Country | US
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Telephone | 805-482-7724
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Fax | 805-618-6250
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MRS. MICHELLE CHRISTINE WONDERS
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Credential | MS, LMFT
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Telephone | 805-482-7724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 49417
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number | 294473
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 29818
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License Number State | CA
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