Provider Demographics
NPI:1538449947
Name:MATTER-KRATZER, FAITH (LMFT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:MATTER-KRATZER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:ANN
Other - Last Name:RUDISILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-0701
Mailing Address - Country:US
Mailing Address - Phone:707-640-1222
Mailing Address - Fax:707-676-8086
Practice Address - Street 1:160 N 1ST ST STE 7
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3042
Practice Address - Country:US
Practice Address - Phone:707-640-1222
Practice Address - Fax:707-676-8086
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100036106H00000X
CAIMF 75516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100036OtherMARRIAGE AND FAMILY THERAPIST LICENSE NUMBER