Healthcare Provider Details

I. General information

NPI: 1053609503
Provider Name (Legal Business Name): BRIDGITTE CAMELIA MATHIASEN LMHC, MSCC, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGITTE ELGHANIMI

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 TALBOT RD S
RENTON WA
98055-6219
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 - ATTN: CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4055
  • Fax: 425-656-5425
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60604127
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberLH60604127
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60604127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: