Provider Demographics
NPI:1679027551
Name:MATHIS, COLBY TYLER (MA LMHC)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:TYLER
Last Name:MATHIS
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0325
Mailing Address - Country:US
Mailing Address - Phone:509-418-9876
Mailing Address - Fax:
Practice Address - Street 1:125 N METHOW VALLEY HWY
Practice Address - Street 2:ROOM 5
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-418-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61260984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health