Healthcare Provider Details

I. General information

NPI: 1447876412
Provider Name (Legal Business Name): MATTHEW FREGOSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE 8520
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE 8520
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 253-780-1174
  • Fax:
Mailing address:
  • Phone: 253-780-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61485464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: