Healthcare Provider Details

I. General information

NPI: 1215850110
Provider Name (Legal Business Name): MICHAEL DOUGLAS MATTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SW 9TH ST
REDMOND OR
97756-2726
US

IV. Provider business mailing address

1153 C AVE
TERREBONNE OR
97760-4908
US

V. Phone/Fax

Practice location:
  • Phone: 503-896-8604
  • Fax:
Mailing address:
  • Phone: 503-896-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: