Provider Demographics
NPI:1023464864
Name:BROWN, MATTHEW (LMFT 113303)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMFT 113303
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 VISTA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7159
Mailing Address - Country:US
Mailing Address - Phone:760-239-9042
Mailing Address - Fax:760-298-5294
Practice Address - Street 1:1134 VISTA BONITA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7159
Practice Address - Country:US
Practice Address - Phone:760-239-9042
Practice Address - Fax:760-298-5294
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113303106H00000X
CAIMF90645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist