Provider Demographics
NPI:1295416634
Name:MATAMALA SANDOVAL, FELIPE ANDRES (PSYM)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:ANDRES
Last Name:MATAMALA SANDOVAL
Suffix:
Gender:M
Credentials:PSYM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 CLISE PL W UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-4027
Mailing Address - Country:US
Mailing Address - Phone:206-604-5106
Mailing Address - Fax:
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 347
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2760
Practice Address - Country:US
Practice Address - Phone:360-805-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61440908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health