Individual
JIMMY LEE MATTO-SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1 BODEGA AVE, SUITE #4, PETALUMA, CA 94952-2666
(707) 762-1670
Mailing address
1 BODEGA AVE, SUITE #4, PETALUMA, CA 94952-2666
(707) 762-1670
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY15031
CA
Other
Enumeration date
07/18/2007
Last updated
07/18/2007
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