NPIMap

Individual provider Active NPI

Lisa Mathews

  • Psychologist
  • Medical Lake, WA
National Provider Identifier
1083035182
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY61048865 Issued in WA
Practice address
850 W. Maple St.
Medical Lake, WA 99022
Phone
(509) 565-4000
Fax
(509) 565-4705
NPI assigned
Dec 17, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2013040148 MO
Psychologist 103T00000X PY61048865 WA Primary

Addresses

Primary practice location

850 W. Maple St.
Medical Lake, WA 99022

Mailing address

P.O. Box 800
Medical Lake, WA 99022
Phone (509) 565-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY61048865WAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Social Past Accepting new patients
Eastern State Hospital Pharmacy PastSince Feb 22, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1083035182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 800",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W. MAPLE ST.",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-17",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2013040148",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY61048865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medical Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.