Provider Demographics
NPI:1780209718
Name:COX, MATTHEW SULLIVAN (MFTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SULLIVAN
Last Name:COX
Suffix:
Gender:M
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W CREMONA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1861
Mailing Address - Country:US
Mailing Address - Phone:620-382-5563
Mailing Address - Fax:
Practice Address - Street 1:650 W CREMONA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1861
Practice Address - Country:US
Practice Address - Phone:620-382-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.61061282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health