MEDICARE: JASPER CORNELIUS MATHER 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
1	101YM0800X	Mental Health Counselor	7900	CA
2	106H00000X	Marriage & Family Therapist	134528	CA

General Provider Information

NPI Number	:	1316331275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASPER CORNELIUS MATHER LMFT

Provider Business Mailing Address
First Line	:	2443 FILLMORE ST # 380-8784
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:	415-393-2585
Fax Number	:	415-393-2909

Provider Business Practice Location Address
First Line	:	2443 FILLMORE ST # 380-8784
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:	415-393-2585
Fax Number	:	415-393-2909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	05/14/2024

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