Provider Demographics
NPI:1891199352
Name:MISSION PSYCHOLOGY GROUP, INC
Entity Type:Organization
Organization Name:MISSION PSYCHOLOGY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-505-2093
Mailing Address - Street 1:PO BOX 6646
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6646
Mailing Address - Country:US
Mailing Address - Phone:714-505-2093
Mailing Address - Fax:
Practice Address - Street 1:17821 E. 17TH ST. STE #250
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:92780
Practice Address - Country:UM
Practice Address - Phone:1858-205-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty