Provider Demographics
NPI:1265860977
Name:HEALY, MATTHEW L (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:L
Last Name:HEALY
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DUESENBERG DR STE 9
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3484
Mailing Address - Country:US
Mailing Address - Phone:818-754-2588
Mailing Address - Fax:
Practice Address - Street 1:141 DUESENBERG DR STE 9
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3484
Practice Address - Country:US
Practice Address - Phone:818-754-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist