Provider Demographics
NPI:1154874915
Name:MCLEAN, MATTHEW DAVID (LMFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22044 CLARENDON ST APT 110
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6318
Mailing Address - Country:US
Mailing Address - Phone:818-252-9009
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3738
Practice Address - Country:US
Practice Address - Phone:213-908-1234
Practice Address - Fax:213-908-1233
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87443106H00000X
CA115650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA115650OtherCALIFORNIA DCA/BBS LMFT LICENSE