Active NPI
Derrik Hunter Mattox-Hanson
- Counselor
- Chehalis, WA
National Provider Identifier
1245038017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG61605542
- Practice address
- 500 SE Washington Ave
Chehalis, WA 98532-3058 - Phone
- (360) 507-8032
- NPI assigned
- Mar 6, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG61605542 | WA | Primary |
Addresses
Primary practice location
500 SE Washington Ave
Chehalis, WA 98532-3058
Mailing address
PO Box 141106
Spokane Valley, WA 99214-1106
Phone (509) 232-5766
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG61605542 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1741219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741219200000",
"number": "1245038017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 141106",
"city": "SPOKANE VALLEY",
"state": "WA",
"postal_code": "992141106",
"telephone_number": "509-232-5766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SE WASHINGTON AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985323058",
"telephone_number": "360-507-8032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOX-HANSON",
"first_name": "DERRIK",
"middle_name": "HUNTER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-06",
"last_updated": "2025-03-06",
"certification_date": "2025-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61605542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.