Healthcare Provider Details

I. General information

NPI: 1194541474
Provider Name (Legal Business Name): MATTHEW SHECHMEISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 CLARENDON AVE FL 2
HUNTINGTON PARK CA
90255-4119
US

IV. Provider business mailing address

155 BIMINI PL
LOS ANGELES CA
90004-5902
US

V. Phone/Fax

Practice location:
  • Phone: 323-584-3700
  • Fax: 323-277-4674
Mailing address:
  • Phone: 213-388-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17658
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: