Provider Demographics
NPI:1548558620
Name:MEYER, MATTHEW (MC, LMHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 CABLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2618
Mailing Address - Country:US
Mailing Address - Phone:360-223-1919
Mailing Address - Fax:
Practice Address - Street 1:1400 LARRABEE AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7428
Practice Address - Country:US
Practice Address - Phone:360-734-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60226862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health