Provider Demographics
NPI:1316006356
Name:ESSELSTROM, MATTHEW CALVIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CALVIN
Last Name:ESSELSTROM
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 1:3620 CHERRYGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-2022
Mailing Address - Country:US
Mailing Address - Phone:209-557-5763
Mailing Address - Fax:209-557-1083
Practice Address - Street 1:1320 STANDIFORD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0726
Practice Address - Country:US
Practice Address - Phone:209-557-5763
Practice Address - Fax:209-557-1083
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist