Provider Demographics
NPI:1043974512
Name:MATTERA, THOMAS (AMFT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MATTERA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 EAST AVE
Mailing Address - Street 2:STE 124 PMB 173
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7349
Mailing Address - Country:US
Mailing Address - Phone:530-588-0448
Mailing Address - Fax:530-636-4888
Practice Address - Street 1:1074 EAST AVE STE A4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1052
Practice Address - Country:US
Practice Address - Phone:530-588-0448
Practice Address - Fax:530-636-4888
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT118412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT118412OtherASSOCIATE MARRIAGE FAMILY THERAPIST LICENSE