Provider Demographics
NPI:1275952632
Name:ENGELKING, MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ENGELKING
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15327 S HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9614
Mailing Address - Country:US
Mailing Address - Phone:509-596-6317
Mailing Address - Fax:
Practice Address - Street 1:5109 NE 82ND AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6841
Practice Address - Country:US
Practice Address - Phone:866-657-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61102709106H00000X
IN35001803A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist