MOSAIC PSYCHOLOGICAL SERVICES, LLC (NPI# 1770011058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770011058 |
| Entity Type | Organization |
| Organization Name | MOSAIC PSYCHOLOGICAL SERVICES, LLC |
| Practice Address |
229 Remington Ave Thomasville GA 31792-5522 |
| Mailing Address |
Po Box 378 Thomasville GA 31799-0378 |
| Practice Telephone | 2292338009 |
| Practice Fax Number | 2292338037 |
| Mailing Telephone | 2292338009 |
| Mailing Fax Number | 2292338037 |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2017-05-31 |
| Authorized Official Name | DR. SHANNON MULLEN MAGBALON (OWNER) |
| Authorized Official Telephone | 2292338009 |
| Authorized Official Credential | PSYCHOLOGIST |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | PSY003712 | GA | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
LCSW004523 | GA | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | LMFT001440 | GA | Behavioral Health & Social Service Providers |
| Y | 103T00000X | Psychologist | PSY003406 | GA | Behavioral Health & Social Service Providers |
| Street Address |
229 REMINGTON AVE |
| City | THOMASVILLE |
| State | GA |
| Zip Code | 31792-5522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053640235 | Shannon D Mullen-magbalon | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5599 | 2009-12-16 |
| 1154976496 | Keri A. Bressette | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5522 | 2019-08-05 |
| 1629585765 | Katherine Harrison | Psychologist | 229 Remington Ave, Thomasville, GA 31792 | 2018-01-10 |
| 1538676671 | North Florida Children's Mental Wellness, LLC | Clinic/Center | 229 Remington Ave, Thomasville, GA 31792 | 2018-01-10 |
| 1720441694 | Carrie Milhous | Counselor | 229 Remington Ave, Thomasville, GA 31792-5522 | 2016-03-30 |
| 1831562826 | David Valpuesta | Marriage & Family Therapist | 229 Remington Ave, Thomasville, GA 31792-5522 | 2015-11-12 |
| 1073913281 | Rachelle Hickcox Cantin | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5522 | 2014-08-26 |
| 1033545785 | Destin Nicole Stewart | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5599 | 2013-09-25 |
| 1821342577 | John D. Richardson | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5599 | 2012-11-02 |
| 1861773632 | Mandy Beth Mullen | Social Worker | 229 Remington Ave, Thomasville, GA 31792-5599 | 2011-09-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739879 | Georgia Pines Community Service Board | Community/Behavioral Health | 407 Cloverdale Drive, Thomasville, GA 31792 | 2018-02-09 |
| 1932613551 | Diana Diaz | Physician Assistant | 2705 E Pinetree Blvd Ste A, Thomasville, GA 31792 | 2017-11-17 |
| 1194249425 | Bobbie Frazier | Contractor | 400 Cloverdale Dr, Thomasville, GA 31792 | 2017-07-28 |
| 1598132292 | Southern Scripts, LLC | Pharmacy | 501 Gordon Avenue, Thomasville, GA 31792 | 2015-08-28 |
| 1508248915 | Elizabeth Nicole Keen | Behavioral Analyst | 121 Covington Ave Apt 9, Thomasville, GA 31792 | 2015-06-22 |
| 1417341579 | Sheila L Stanley | Counselor | 301 Summercreek Cove, Thomasville, GA 31792 | 2015-03-26 |
| 1457749301 | Ashley Lamb | Speech-Language Pathologist | 1203 East Jackson Street, Thomasville, GA 31792 | 2014-12-30 |
| 1831403880 | Somnoquest | Durable Medical Equipment & Medical Supplies | 556 Hall Road, Thomasville, GA 31792 | 2010-08-02 |
| 1508000183 | Kashyap B Choksi | Internal Medicine | 100 Mimosa Drive 2nd Floor, Thomasville, GA 31792 | 2009-04-27 |
| 1205008786 | Mark J Glaccum | Chiropractor | 415 Gordon Avenue, Thomasville, GA 31792 | 2008-03-25 |
| Find all providers in zip 31792 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740259480 | Joseph M Garmon | Psychologist | 503 Remington Ave, Thomasville, GA 31792-5634 | 2006-03-15 |
| 1588659643 | Nina Elizabeth Tocci | Psychologist | 30853 Highway 43, Thomasville, AL 36784-2513 | 2005-09-15 |
| 1386297471 | Jennifer Ross | Psychologist | 200 Gordon Ave, Thomasville, GA 31792-6640 | 2019-07-18 |
| 1629585765 | Katherine Harrison | Psychologist | 229 Remington Ave, Thomasville, GA 31792 | 2018-01-10 |
| 1174900088 | Nicki Taylor | Psychologist | 200 Gordon Ave, Thomasville, GA 31792-6640 | 2015-04-29 |
| 1073913281 | Rachelle Hickcox Cantin | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5522 | 2014-08-26 |
| 1891101556 | Tracy L. Shelby | Psychologist | 200 Gordon Ave, Thomasville, GA 31792-6640 | 2014-07-02 |
| 1033545785 | Destin Nicole Stewart | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5599 | 2013-09-25 |
| 1801238464 | Cynthia Michelle Solecki | Psychologist | 400 S Pinetree Blvd, Thomasville, GA 31792-7128 | 2013-07-24 |
| 1821342577 | John D. Richardson | Psychologist | 229 Remington Ave, Thomasville, GA 31792-5599 | 2012-11-02 |
| Find all providers in THOMASVILLE | ||||
| City | THOMASVILLE |
| Zip Code | 31792 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.