Provider Demographics
NPI:1740643733
Name:MATTER, BECKY JEAN (CP 60169680)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:JEAN
Last Name:MATTER
Suffix:
Gender:F
Credentials:CP 60169680
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12598
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-2598
Mailing Address - Country:US
Mailing Address - Phone:425-259-5842
Mailing Address - Fax:425-259-0243
Practice Address - Street 1:2732 GRAND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3416
Practice Address - Country:US
Practice Address - Phone:425-259-5842
Practice Address - Fax:425-259-0243
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60169680101YA0400X
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)