Provider Demographics
NPI:1053609503
Name:MATHIASEN, BRIDGITTE CAMELIA (LMHC, MSCC, BS)
Entity type:Individual
Prefix:
First Name:BRIDGITTE
Middle Name:CAMELIA
Last Name:MATHIASEN
Suffix:
Gender:F
Credentials:LMHC, MSCC, BS
Other - Prefix:
Other - First Name:BRIDGITTE
Other - Middle Name:
Other - Last Name:ELGHANIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 - ATTN: CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-228-3440
Mailing Address - Fax:
Practice Address - Street 1:4445 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6219
Practice Address - Country:US
Practice Address - Phone:425-656-4055
Practice Address - Fax:425-656-5425
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 273R00000X, 1041C0700X, 101YA0400X
WALH60604127101YP2500X, 102L00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No273R00000XHospital UnitsPsychiatric Unit
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2074643Medicaid