Provider Demographics
NPI:1801324991
Name:JOHNSON, MATTHEW ALLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:GALVIN
Mailing Address - State:WA
Mailing Address - Zip Code:98544-0247
Mailing Address - Country:US
Mailing Address - Phone:360-262-4352
Mailing Address - Fax:360-450-3023
Practice Address - Street 1:2451 NE KRESKY AVE UNIT E
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2436
Practice Address - Country:US
Practice Address - Phone:360-262-4352
Practice Address - Fax:360-450-3023
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60489916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty