Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003400458 |
---|---|
Provider Name | Matthew Dean |
First Address | San Luis Obispo, CA 93401-7741 |
Second Address | San Luis Obispo, CA 93401-7741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2021 |
Last Update Date | 25/02/2021 |