Provider Demographics
NPI:1528170008
Name:MATTUS, GREGORY J (LMHC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MATTUS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:J
Other - Last Name:MATTUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:118 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6129
Mailing Address - Country:US
Mailing Address - Phone:360-457-0431
Mailing Address - Fax:360-457-0493
Practice Address - Street 1:118 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6129
Practice Address - Country:US
Practice Address - Phone:360-457-0431
Practice Address - Fax:360-457-0493
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60596191101YM0800X
NM0126111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional