Provider Demographics
NPI:1396816757
Name:MATTHEWS, EMMALINE SARA (MFT)
Entity type:Individual
Prefix:
First Name:EMMALINE
Middle Name:SARA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1614
Mailing Address - Country:US
Mailing Address - Phone:415-830-0597
Mailing Address - Fax:650-376-9883
Practice Address - Street 1:370 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1614
Practice Address - Country:US
Practice Address - Phone:415-830-0597
Practice Address - Fax:650-376-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist