Basic Information
| Provider Information | |||||||||
| NPI: | 1518295799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADER | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29325 KIMBERLINA RD | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617584029 | ||||||||
| FaxNumber: | 6617580891 | ||||||||
| Practice Location | |||||||||
| Address1: | 2731 NUGGET AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE ISABELLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932409456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603793412 | ||||||||
| FaxNumber: | 7603795332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2009 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 41790 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.