Provider Demographics
NPI:1295806826
Name:MATLEN, CAROLE M (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:M
Last Name:MATLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24311 JACARANDA DR
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8326
Mailing Address - Country:US
Mailing Address - Phone:661-265-5032
Mailing Address - Fax:661-821-2204
Practice Address - Street 1:24311 JACARANDA DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8326
Practice Address - Country:US
Practice Address - Phone:661-265-5032
Practice Address - Fax:661-821-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY174610Medicare ID - Type UnspecifiedNETWORK PROVIDERPSYCHOLOG