Provider Demographics
NPI:1942009741
Name:RENTON, MATT B
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:B
Last Name:RENTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 GREENWOOD AVE N APT 14
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3629
Mailing Address - Country:US
Mailing Address - Phone:206-291-6082
Mailing Address - Fax:
Practice Address - Street 1:2310 130TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1799
Practice Address - Country:US
Practice Address - Phone:425-882-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61591880106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician