Provider Demographics
NPI:1053862136
Name:REINO, MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:REINO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S B ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3609
Mailing Address - Country:US
Mailing Address - Phone:714-462-9876
Mailing Address - Fax:
Practice Address - Street 1:130 S B ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3609
Practice Address - Country:US
Practice Address - Phone:714-462-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF73908106H00000X
CA97638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist