Healthcare Provider Details

I. General information

NPI: 1144360488
Provider Name (Legal Business Name): MATT KECK MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/03/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TEMPLE ST.
MONTARA CA
94037
US

IV. Provider business mailing address

PO BOX 371420
MONTARA CA
94037-1420
US

V. Phone/Fax

Practice location:
  • Phone: 650-556-4565
  • Fax:
Mailing address:
  • Phone: 650-556-4565
  • Fax: 650-704-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: