Provider Demographics
NPI:1174955991
Name:COREY, MATTHEW W (MA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:W
Last Name:COREY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 SE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3728
Mailing Address - Country:US
Mailing Address - Phone:503-975-0355
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FRTH PLN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7369
Practice Address - Country:US
Practice Address - Phone:360-993-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health