Provider Demographics
NPI:1790225985
Name:METTEN, ANTHONY (MFTI)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:METTEN
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112017
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-2017
Mailing Address - Country:US
Mailing Address - Phone:408-529-3778
Mailing Address - Fax:
Practice Address - Street 1:825 SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4635
Practice Address - Country:US
Practice Address - Phone:408-529-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF70928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist