Healthcare Provider Details

I. General information

NPI: 1982217881
Provider Name (Legal Business Name): MATTIE LYNN CALAME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21143 PLACERITA CANYON RD
SANTA CLARITA CA
91321-1922
US

IV. Provider business mailing address

20501 VENTURA BLVD STE 170
WOODLAND HILLS CA
91364-6258
US

V. Phone/Fax

Practice location:
  • Phone: 805-816-2024
  • Fax:
Mailing address:
  • Phone: 818-821-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-130611
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: