Provider Demographics
NPI:1639673841
Name:SMITH, MATTHEW ANDERSON (LMHCA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANDERSON
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4313
Mailing Address - Country:US
Mailing Address - Phone:503-778-0573
Mailing Address - Fax:
Practice Address - Street 1:600 N 36TH ST STE 327
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8699
Practice Address - Country:US
Practice Address - Phone:503-778-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60566709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty