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General NPI Number Information
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NPI Number | 1952586943
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Entity Type | Individual
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Provider Name | STACIE LEA MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1550 CALIFORNIA ST
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City | REDDING
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State | CA
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Zip | 96001-1003
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Country | US
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Telephone | 530-245-6769
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 SPANIEL CT
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City | REDDING
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State | CA
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Zip | 96003-4556
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Country | US
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Telephone | 530-209-4334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 152194
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License Number State | CA
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