Provider Demographics
NPI:1902110018
Name:MATISEK, KALIE A (LMFT 98951)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:A
Last Name:MATISEK
Suffix:
Gender:F
Credentials:LMFT 98951
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3027
Mailing Address - Country:US
Mailing Address - Phone:805-652-0599
Mailing Address - Fax:805-652-0608
Practice Address - Street 1:1065 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3027
Practice Address - Country:US
Practice Address - Phone:805-652-0599
Practice Address - Fax:805-652-0608
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71076106H00000X
171M00000X
CA98951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator