Healthcare Provider Details

I. General information

NPI: 1134052640
Provider Name (Legal Business Name): MATTHEW DANIEL AHRENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 KATHERINE AVE
REDWOOD CITY CA
94062-1320
US

IV. Provider business mailing address

570 EL CAMINO REAL STE 150, #109
REDWOOD CITY CA
94063-1262
US

V. Phone/Fax

Practice location:
  • Phone: 650-242-5689
  • Fax:
Mailing address:
  • Phone: 650-242-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: