MEDICARE: MATINE SHAYGAN 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
1	101YM0800X	Mental Health Counselor	IMF48966	CA

General Provider Information

NPI Number	:	1730388810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATINE SHAYGAN MFTI

Provider Business Mailing Address
First Line	:	1330 BROADWAY
Second Line	:	SUITE 732
City	:	OAKLAND
State	:	CA
Zip	:	94612-2503
Country	:	US
Telephone Number	:	510-451-0661
Fax Number	:	510-451-0662

Provider Business Practice Location Address
First Line	:	1330 BROADWAY
Second Line	:	SUITE 732
City	:	OAKLAND
State	:	CA
Zip	:	94612-2503
Country	:	US
Telephone Number	:	510-451-0661
Fax Number	:	510-451-0662

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/14/2014

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Directions to “ MATINE SHAYGAN MFTI” Practice Location

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