Provider Demographics
NPI:1588553465
Name:MATTEK, MARK W (LPCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:MATTEK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BELLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1708
Mailing Address - Country:US
Mailing Address - Phone:602-327-0614
Mailing Address - Fax:
Practice Address - Street 1:316 BELLEVIEW DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1708
Practice Address - Country:US
Practice Address - Phone:602-327-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health