Healthcare Provider Details

I. General information

NPI: 1295416634
Provider Name (Legal Business Name): FELIPE ANDRES MATAMALA SANDOVAL PSY.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 FRYELANDS BLVD SE STE 347
MONROE WA
98272-2760
US

IV. Provider business mailing address

1933 CLISE PL W UNIT B
SEATTLE WA
98199-4027
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-3122
  • Fax:
Mailing address:
  • Phone: 206-604-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61440908
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61543449
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: