Healthcare Provider Details

I. General information

NPI: 1598208803
Provider Name (Legal Business Name): MATTHEW ALLEN TAYLOR LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CHALLENGER WAY # 7
SANTA ROSA CA
95407-5441
US

IV. Provider business mailing address

2255 CHALLENGER WAY STE 107
SANTA ROSA CA
95407-5423
US

V. Phone/Fax

Practice location:
  • Phone: 707-239-3874
  • Fax:
Mailing address:
  • Phone: 707-565-4797
  • Fax:

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 Number135285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: