Healthcare Provider Details

I. General information

NPI: 1952132185
Provider Name (Legal Business Name): MATTHEW CECIL MAXFIELD ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 7TH AVE SE STE 100
LACEY WA
98503-1055
US

IV. Provider business mailing address

4401 SHALE ST SE
LACEY WA
98503-2172
US

V. Phone/Fax

Practice location:
  • Phone: 360-338-3757
  • Fax: 253-442-6160
Mailing address:
  • Phone: 608-217-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61104712
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70011789
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: