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General NPI Number Information
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NPI Number | 1285112433
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Entity Type | Individual
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Provider Name | MATTHEW IRA ROBERTS CP 61222010
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Gender | Male
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1601 W MEEKER ST STE 201
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City | KENT
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State | WA
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Zip | 98032-4323
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Country | US
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Telephone | 206-550-5894
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 S LANE ST
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City | SEATTLE
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State | WA
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Zip | 98144-2829
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Country | US
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Telephone | 253-355-9888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP61222010
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License Number State | WA
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