Healthcare Provider Details

I. General information

NPI: 1851213979
Provider Name (Legal Business Name): MIA MCKELVEY MOREHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 W BRANCH ST STE A
ARROYO GRANDE CA
93420-6616
US

IV. Provider business mailing address

3940 BROAD ST # 126
SAN LUIS OBISPO CA
93401-7017
US

V. Phone/Fax

Practice location:
  • Phone: 805-801-2231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: