Provider Demographics
NPI:1336531060
Name:DEMATTY, GLENDA (LMHC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:DEMATTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0216
Mailing Address - Country:US
Mailing Address - Phone:253-432-6126
Mailing Address - Fax:
Practice Address - Street 1:2727 HOLLYCROFT ST STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-432-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X
WAMC60692217101YM0800X
WALH61128052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60692217OtherLMHCA
WALH61128052OtherLMHC
WACG 60535559OtherAAC CREDENTIAL NUMBER