Provider Demographics
NPI:1033786934
Name:MATT, MALEIA MICHELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:MALEIA
Middle Name:MICHELLE
Last Name:MATT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 E 34TH CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-8367
Mailing Address - Country:US
Mailing Address - Phone:253-732-1085
Mailing Address - Fax:
Practice Address - Street 1:422 W RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0303
Practice Address - Country:US
Practice Address - Phone:253-732-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610172141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical