Healthcare Provider Details

I. General information

NPI: 1245713056
Provider Name (Legal Business Name): ALEXANDRA BROOKE MATHEWES LMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27035 228TH PL SE
MAPLE VALLEY WA
98038-7945
US

IV. Provider business mailing address

27035 228TH PL SE
MAPLE VALLEY WA
98038-7945
US

V. Phone/Fax

Practice location:
  • Phone: 773-372-4583
  • Fax:
Mailing address:
  • Phone: 773-372-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011748
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61127497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: