Provider Demographics
NPI:1033240122
Name:MATHIS, JAMES LARKIN (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LARKIN
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2802
Mailing Address - Country:US
Mailing Address - Phone:530-247-3365
Mailing Address - Fax:530-247-3383
Practice Address - Street 1:2400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2802
Practice Address - Country:US
Practice Address - Phone:530-247-3365
Practice Address - Fax:530-247-3383
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist