Provider Demographics
NPI:1104208610
Name:STEPHENS, MATTHEW (CDPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:WA
Mailing Address - Zip Code:98542-9705
Mailing Address - Country:US
Mailing Address - Phone:360-520-2670
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4556
Practice Address - Country:US
Practice Address - Phone:360-687-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical