Provider Demographics
NPI:1811364276
Name:MATTHEW-SOPOREAN, NESLYN
Entity Type:Individual
Prefix:
First Name:NESLYN
Middle Name:
Last Name:MATTHEW-SOPOREAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 NE 66TH AVE APT 30
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2462
Mailing Address - Country:US
Mailing Address - Phone:857-406-6461
Mailing Address - Fax:
Practice Address - Street 1:4721 NE 66TH AVE APT 30
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2462
Practice Address - Country:US
Practice Address - Phone:857-406-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor