Provider Demographics
NPI:1609204205
Name:WOLFE, MATTHEW JUSTIN (MA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JUSTIN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 196TH ST SW
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6430
Mailing Address - Country:US
Mailing Address - Phone:425-835-5881
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6430
Practice Address - Country:US
Practice Address - Phone:425-835-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program