Provider Demographics
NPI:1801460845
Name:MATSON, LEAH NADETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:NADETTE
Last Name:MATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28970 OAK CREEK LN APT 1709
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6440
Mailing Address - Country:US
Mailing Address - Phone:310-383-9889
Mailing Address - Fax:
Practice Address - Street 1:2812 SANTA MONICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2432
Practice Address - Country:US
Practice Address - Phone:310-383-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherNONE