Provider Demographics
NPI:1609689470
Name:BRASFIELD, MATTHEW FORREST (BS, SUDPT, AAC, CPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FORREST
Last Name:BRASFIELD
Suffix:
Gender:
Credentials:BS, SUDPT, AAC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4808
Mailing Address - Country:US
Mailing Address - Phone:360-685-6198
Mailing Address - Fax:
Practice Address - Street 1:1905 CONTINENTAL PLACE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5633
Practice Address - Country:US
Practice Address - Phone:360-755-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61632437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)