Healthcare Provider Details

I. General information

NPI: 1689715617
Provider Name (Legal Business Name): MATTHEW DAVID COMRIE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 SE 270TH PL SUITE 203
COVINGTON WA
98042-5431
US

IV. Provider business mailing address

PO BOX 8481
COVINGTON WA
98042-0052
US

V. Phone/Fax

Practice location:
  • Phone: 253-639-3773
  • Fax: 253-638-7465
Mailing address:
  • Phone: 253-639-3773
  • Fax: 253-638-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: