Provider Demographics
NPI:1558712323
Name:MCNUTT, MATTHEW (IMF, CATC-IV)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:IMF, CATC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SAINT CHARLES DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3982
Mailing Address - Country:US
Mailing Address - Phone:800-247-6111
Mailing Address - Fax:805-374-1912
Practice Address - Street 1:555 SAINT CHARLES DR
Practice Address - Street 2:SUITE 103
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3982
Practice Address - Country:US
Practice Address - Phone:800-247-6111
Practice Address - Fax:805-374-1912
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist