Healthcare Provider Details

I. General information

NPI: 1295806826
Provider Name (Legal Business Name): CAROLE M. MATLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24311 JACARANDA DR
TEHACHAPI CA
93561-8326
US

IV. Provider business mailing address

24311 JACARANDA DR
TEHACHAPI CA
93561-8326
US

V. Phone/Fax

Practice location:
  • Phone: 661-265-5032
  • Fax: 661-821-2204
Mailing address:
  • Phone: 661-265-5032
  • Fax: 661-821-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: