Provider Demographics
NPI:1639932676
Name:HOWARD, TED MATHEW (MA, AMFT)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:MATHEW
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 VISTA DEL MAR APT 169
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8824
Mailing Address - Country:US
Mailing Address - Phone:607-227-0477
Mailing Address - Fax:
Practice Address - Street 1:6204 VISTA DEL MAR APT 169
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8824
Practice Address - Country:US
Practice Address - Phone:607-227-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT124359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist