Provider Demographics
NPI:1144497306
Name:BENNETT, MATTHEW (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 S VICTORIA AVE STE F
Mailing Address - Street 2:#392
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6190
Mailing Address - Country:US
Mailing Address - Phone:805-339-9872
Mailing Address - Fax:
Practice Address - Street 1:701 E SANTA CLARA ST STE 28D
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-5960
Practice Address - Country:US
Practice Address - Phone:805-339-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC449101YP2500X
CALMFT37872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional