Healthcare Provider Details

I. General information

NPI: 1467990812
Provider Name (Legal Business Name): MATHEW METZGAR LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 KNOLL LN
MILL VALLEY CA
94941-2326
US

IV. Provider business mailing address

PO BOX 9035
SANTA ROSA CA
95405-1035
US

V. Phone/Fax

Practice location:
  • Phone: 415-699-9275
  • Fax:
Mailing address:
  • Phone: 415-699-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT117100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: