Provider Demographics
NPI:1245487495
Name:DE LA MATER, DAWN DENISE (LMFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DENISE
Last Name:DE LA MATER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 POLLASKY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1159
Mailing Address - Country:US
Mailing Address - Phone:559-754-3011
Mailing Address - Fax:559-326-0607
Practice Address - Street 1:106 POLLASKY AVE STE D
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1159
Practice Address - Country:US
Practice Address - Phone:559-754-3011
Practice Address - Fax:553-326-0607
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7951101YA0400X
CA146033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)