MEDICARE: MATTHEW B RUSSELL

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
1	106H00000X	Marriage & Family Therapist	AMFT122031	CA

General Provider Information

NPI Number	:	1386244648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW B RUSSELL

Provider Business Mailing Address
First Line	:	4125 TEMESCAL ST STE G
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7558
Country	:	US
Telephone Number	:	916-619-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 TEMESCAL ST STE G
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7558
Country	:	US
Telephone Number	:	916-619-7744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

Similar Medicare Providers

1164427845 — MRS. JUDITH DEE FIELDS
Practice Location Address:

4125 TEMESCAL ST , STE J
FAIR OAKS, CA
95628-7558

Practice Phone: 916-965-4012
Practice Fax: 916-965-1082

1700383718 — WHOLE SOUL COUNSELING A LICENSED CLINICAL SOCIAL WORKER PC
Practice Location Address:

4125 TEMESCAL ST STE A
FAIR OAKS, CA
95628-7558

Practice Phone: 916-877-6894
Practice Fax:

1760056113 — HANNAH BROOKS AMFT, APCC
Practice Location Address:

4125 TEMESCAL ST STE G
FAIR OAKS, CA
95628-7558

Practice Phone: 916-619-7744
Practice Fax:

1881355584 — FLIN SADE OSHUN
Practice Location Address:

4125 TEMESCAL ST
FAIR OAKS, CA
95628-7558

Practice Phone: 916-439-8211
Practice Fax:

1760133300 — ALEXA NICHOLE KIDMAN
Practice Location Address:

4125 TEMESCAL ST
FAIR OAKS, CA
95628-7558

Practice Phone: 916-877-6894
Practice Fax:

1396491585 — ANDREA NOELLE DIEMERT LMFT, LAADC, ICAADC
Practice Location Address:

4125 TEMESCAL ST
FAIR OAKS, CA
95628-7558

Practice Phone: 562-206-5444
Practice Fax:

Directions to “ MATTHEW B RUSSELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.