Healthcare Provider Details

I. General information

NPI: 1437973914
Provider Name (Legal Business Name): NEUROMINDS FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 H ST STE 5000
CHULA VISTA CA
91910-5561
US

IV. Provider business mailing address

333 H ST STE 5000
CHULA VISTA CA
91910-5561
US

V. Phone/Fax

Practice location:
  • Phone: 619-616-2969
  • Fax: 888-464-4213
Mailing address:
  • Phone: 619-751-2386
  • Fax: 888-464-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN CORSON
Title or Position: OWNER
Credential:
Phone: 804-644-0774