Healthcare Provider Details

I. General information

NPI: 1174680276
Provider Name (Legal Business Name): MARIE TERESE MATTESON MS LMT HP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE TERESE MATTESON-OLSEN

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 PORTAL WAY
FERNDALE WA
98248-8316
US

IV. Provider business mailing address

6335 PORTAL WAY
FERNDALE WA
98248-8316
US

V. Phone/Fax

Practice location:
  • Phone: 360-815-7180
  • Fax:
Mailing address:
  • Phone: 360-815-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberRC52217
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.00010351
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberHP60104589
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number1164236
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: