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NPI Code Detail

MEDICARE: JAMES LARKIN MATHIS MA, MFTI

MEDICARE: JAMES LARKIN MATHIS MA, MFTI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistIMF 49890CA

General Provider Information

NPI Number : 1033240122
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES LARKIN MATHIS MA, MFTI
Provider Business Mailing Address
First Line : 2400 WASHINGTON AVE
Second Line :
City : REDDING
State : CA
Zip : 96001-2802
Country : US
Telephone Number : 530-247-3365
Fax Number : 530-247-3383
Provider Business Practice Location Address
First Line : 2400 WASHINGTON AVE
Second Line :
City : REDDING
State : CA
Zip : 96001-2802
Country : US
Telephone Number : 530-247-3365
Fax Number : 530-247-3383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 02/09/2011

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