Healthcare Provider Details

I. General information

NPI: 1356051817
Provider Name (Legal Business Name): MATTHEW RYAN TRICOLA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SW FINCH WAY
PULLMAN WA
99163-5826
US

IV. Provider business mailing address

855 SW FINCH WAY
PULLMAN WA
99163-5826
US

V. Phone/Fax

Practice location:
  • Phone: 509-508-1304
  • Fax:
Mailing address:
  • Phone: 509-508-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70135982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: