Provider Demographics
NPI:1730388810
Name:SHAYGAN, MATINE (MFTI)
Entity type:Individual
Prefix:
First Name:MATINE
Middle Name:
Last Name:SHAYGAN
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BROADWAY
Mailing Address - Street 2:SUITE 732
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2503
Mailing Address - Country:US
Mailing Address - Phone:510-451-0661
Mailing Address - Fax:510-451-0662
Practice Address - Street 1:1330 BROADWAY
Practice Address - Street 2:SUITE 732
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2503
Practice Address - Country:US
Practice Address - Phone:510-451-0661
Practice Address - Fax:510-451-0662
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health