Mathew Bergendahl
Individual provider Active NPI Professional Counselor · Olympia, WA
NPI 1043946817 · NPPES record last updated Jul 25, 2022
Key facts
- NPI
- 1043946817
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC20177 (SD)
- Practice address
- 5419 Courtney St SE
Olympia, WA 98513-4613 - Phone
- (360) 451-0611
- NPI assigned
- Jul 25, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC20177 | SD | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jban, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | LPC20177 | SD | Yes |
Addresses
Primary practice location
5419 Courtney St SE
Olympia, WA 98513-4613
Mailing address
5419 Courtney St SE
Olympia, WA 98513-4613
Phone (360) 451-0611
Other providers in Olympia, WA
- William Beppu
- Ursula Diksha Berebitsky
- Amy Berg
- Caitlin Rose Berg
- Jackie Marie Berge
- Matthew S Berger
- Philip William Berger
- Jude Bergkamp
- Michael I Bergman
- Bobbie Berkey
All providers in Olympia, WA · Professional Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.