Healthcare Provider Details

I. General information

NPI: 1134009665
Provider Name (Legal Business Name): KARI ANN MATHES LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5612 112TH ST E APT C
PUYALLUP WA
98373-3211
US

IV. Provider business mailing address

5612 112TH ST E APT C
PUYALLUP WA
98373-3211
US

V. Phone/Fax

Practice location:
  • Phone: 912-596-8779
  • Fax:
Mailing address:
  • Phone: 912-596-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70024612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: