Basic Information
| Provider Information | |||||||||
| NPI: | 1992873459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTOX | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 TECHNOLOGY DR | ||||||||
| Address2: | #2030 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088212028 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 E VIRGINIA ST | ||||||||
| Address2: | #280 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082876200 | ||||||||
| FaxNumber: | 4089981535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.