Provider Demographics
NPI:1639295710
Name:MATTSON, TAMARA MARIE-SUE (LMHC)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:MARIE-SUE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-384-7131
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST STE 2400
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-734-0615
Practice Address - Fax:360-312-4218
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60233712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-2298135OtherIRS EMPLOYER IDENTIFICATION NUMBER
WA603284323 LLCOtherUNIFIED BUSINESS IDENTIFYER