Healthcare Provider Details

I. General information

NPI: 1053192781
Provider Name (Legal Business Name): LAUREN MATERN LMFT#164054
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MURPHY AVE STE 200-4010
SUNNYVALE CA
94086-6110
US

IV. Provider business mailing address

PO BOX 1184
PALOS VERDES ESTATES CA
90274-7984
US

V. Phone/Fax

Practice location:
  • Phone: 310-810-3329
  • Fax:
Mailing address:
  • Phone: 310-810-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: