Healthcare Provider Details

I. General information

NPI: 1912840075
Provider Name (Legal Business Name): BRADY MATHIESON LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 N NORTHGATE WAY STE 216
SEATTLE WA
98133-9018
US

IV. Provider business mailing address

516 SUMMIT AVE E APT 102
SEATTLE WA
98102-6715
US

V. Phone/Fax

Practice location:
  • Phone: 206-385-9636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61585205
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: