Provider Demographics
NPI:1720604267
Name:MCNICHOL, MATTHEW O'BRIEN (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:O'BRIEN
Last Name:MCNICHOL
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 1:851 CHERRY AVE # 2722
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2900
Mailing Address - Country:US
Mailing Address - Phone:650-245-4867
Mailing Address - Fax:
Practice Address - Street 1:851 CHERRY AVE # 2722
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2900
Practice Address - Country:US
Practice Address - Phone:650-245-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CALMFT142991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program