Provider Demographics
NPI:1285880989
Name:MATHEWS, CARLY DENISE
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:DENISE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARLY
Other - Middle Name:DENISE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35621 REESE RD
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-8635
Mailing Address - Country:US
Mailing Address - Phone:425-374-5861
Mailing Address - Fax:425-290-7485
Practice Address - Street 1:811 MADISON ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4543
Practice Address - Country:US
Practice Address - Phone:425-374-5861
Practice Address - Fax:425-290-7485
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor