Provider Demographics
NPI:1003515065
Name:PHIPPS, MATTHEW ELIAS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ELIAS
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4580
Mailing Address - Country:US
Mailing Address - Phone:425-542-7382
Mailing Address - Fax:
Practice Address - Street 1:310 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4580
Practice Address - Country:US
Practice Address - Phone:738-254-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-22-204300106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician