Healthcare Provider Details

I. General information

NPI: 1457740227
Provider Name (Legal Business Name): MATTHEW C DUPRIEST M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7369
US

IV. Provider business mailing address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7369
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3065
  • Fax: 360-993-3047
Mailing address:
  • Phone: 360-993-3065
  • Fax: 360-993-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number388-865-0150
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: