Provider Demographics
NPI:1669135497
Name:MATTHEWS, MONICA (LMHCA, MHP, SUDPT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMHCA, MHP, SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3431
Mailing Address - Country:US
Mailing Address - Phone:425-771-5166
Mailing Address - Fax:
Practice Address - Street 1:547 DAYTON ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3431
Practice Address - Country:US
Practice Address - Phone:425-771-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61047058101YA0400X
WAMC60799010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty