Provider Demographics
NPI:1174680276
Name:MATTESON, MARIE TERESE (MS LMT RC CCHT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:TERESE
Last Name:MATTESON
Suffix:
Gender:F
Credentials:MS LMT RC CCHT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:TERESE
Other - Last Name:MATTESON-OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 GIRARD ST
Mailing Address - Street 2:ALTERNATE ADDRESS 3 SPRING ROAD
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4004
Mailing Address - Country:US
Mailing Address - Phone:360-815-7180
Mailing Address - Fax:
Practice Address - Street 1:414 GIRARD ST
Practice Address - Street 2:ALTNERATE ADDRESS 3 SPRING ROAD
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4004
Practice Address - Country:US
Practice Address - Phone:360-815-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC52217101YP1600X
WA1164236146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC52217OtherREGISTERED COUNSELOR
WAHP60104589OtherSTATE OF WASHINGTON DOH
WAMA10351OtherLIC MASSAGE PRACTITIIONER