Basic Information
| Provider Information | |||||||||
| NPI: | 1164812459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | MCGLAUGHLIN | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 3RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919111352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 3RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919111352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | ASW71421 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.