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NPI Code Detail

MEDICARE: MATEUS PORTER LMFT

MEDICARE: MATEUS PORTER LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor100817CA
2106H00000XMarriage & Family Therapist100817CA

General Provider Information

NPI Number : 1164886842
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATEUS PORTER LMFT
Provider Business Mailing Address
First Line : 1700 S AMPHLETT BLVD STE 250E
Second Line :
City : SAN MATEO
State : CA
Zip : 94402-2728
Country : US
Telephone Number : 650-549-5683
Fax Number :
Provider Business Practice Location Address
First Line : 1486 HUNTINGTON AVE STE 100
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-5971
Country : US
Telephone Number : 650-877-8642
Fax Number : 628-239-0525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2016
Last Update Date : 05/27/2021

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Directions to “ MATEUS PORTER LMFT” Practice Location

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