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NPI Code Detail

MEDICARE: MATTHEW JAMES REDDAM MS, MFT

MEDICARE: MATTHEW JAMES REDDAM MS, MFT
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 Therapist50734CA
2106H00000XMarriage & Family Therapist45681CA

General Provider Information

NPI Number : 1922122050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JAMES REDDAM MS, MFT
Provider Business Mailing Address
First Line : 2251 SAINT GEORGE LN STE G
Second Line :
City : CHICO
State : CA
Zip : 95926-1359
Country : US
Telephone Number : 530-342-7686
Fax Number :
Provider Business Practice Location Address
First Line : 2251 SAINT GEORGE LN STE G
Second Line :
City : CHICO
State : CA
Zip : 95926-1359
Country : US
Telephone Number : 530-342-7686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 05/02/2011

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