Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | CA | |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1336370956 |
---|---|
Provider Name | Matthew James Messina |
First Address | Paradise, CA 95969-3280 |
Second Address | Paradise, CA 95969-3280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 29/05/2012 |