Healthcare Provider Details

I. General information

NPI: 1992600043
Provider Name (Legal Business Name): MIND & MOTION FAMILY THERAPY, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 SUNSET AVE
MORRO BAY CA
93442-1647
US

IV. Provider business mailing address

630 QUINTANA RD STE 222
MORRO BAY CA
93442-1939
US

V. Phone/Fax

Practice location:
  • Phone: 805-704-4007
  • Fax:
Mailing address:
  • Phone: 805-704-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIAN J. VARELA
Title or Position: OWNER
Credential: LMFT
Phone: 805-704-4007