Healthcare Provider Details

I. General information

NPI: 1679485023
Provider Name (Legal Business Name): MATTHEW MOORHEAD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W SHAW AVE STE D1
FRESNO CA
93711-3513
US

IV. Provider business mailing address

9339 NORTHVIEW RD
MIDDLETON ID
83644-5048
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-9181
  • Fax:
Mailing address:
  • Phone: 559-667-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MATTHEW R MOORHEAD
Title or Position: LMFT
Credential: M.A. LMFT
Phone: 559-667-1076