Provider Demographics
NPI:1568897734
Name:MATHEWS, KEL (LMFT)
Entity Type:Individual
Prefix:
First Name:KEL
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 E OCEAN BLVD UNIT 211
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5448
Mailing Address - Country:US
Mailing Address - Phone:972-880-1825
Mailing Address - Fax:
Practice Address - Street 1:1605 N SPURGEON ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2355
Practice Address - Country:US
Practice Address - Phone:972-880-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA81575106H00000X
CA103242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)