Healthcare Provider Details

I. General information

NPI: 1649036898
Provider Name (Legal Business Name): CODY MATTHEW WESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 S LOS ROBLES AVE
PASADENA CA
91101-3841
US

IV. Provider business mailing address

417 MONROVISTA AVE UNIT A
MONROVIA CA
91016-4633
US

V. Phone/Fax

Practice location:
  • Phone: 626-737-4335
  • Fax:
Mailing address:
  • Phone: 904-657-7109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15238
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: