Healthcare Provider Details

I. General information

NPI: 1750228755
Provider Name (Legal Business Name): KIND MIND FAMILY COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13358 HERNE BAY CT
MOORPARK CA
93021-1998
US

IV. Provider business mailing address

13358 HERNE BAY CT
MOORPARK CA
93021-1998
US

V. Phone/Fax

Practice location:
  • Phone: 805-616-9935
  • Fax:
Mailing address:
  • Phone: 805-616-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MEHGAN LYNN BLUM
Title or Position: PRACTICE MANAGER
Credential: APCC
Phone: 805-616-9935