Provider Demographics
NPI:1437342888
Name:TIEMEYER, MATTHEW (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TIEMEYER
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 5TH AVE S STE 203C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3632
Mailing Address - Country:US
Mailing Address - Phone:425-275-2198
Mailing Address - Fax:
Practice Address - Street 1:420 5TH AVE S STE 203C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3632
Practice Address - Country:US
Practice Address - Phone:425-275-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health