Healthcare Provider Details

I. General information

NPI: 1336370956
Provider Name (Legal Business Name): MATTHEW JAMES MESSINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 SKYWAY
PARADISE CA
95969-3280
US

IV. Provider business mailing address

7200 SKYWAY
PARADISE CA
95969-3280
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-1965
  • Fax: 530-872-7784
Mailing address:
  • Phone: 530-877-1965
  • Fax: 530-872-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: