Matthew Vaughn Edward Provost | Seattle, WA • PECOS Search

Matthew Vaughn Edward Provost

Counselor

Behavioral Health & Social Service Providers

1700 Airport Way S, Seattle, WA 98134-1618

PECOS Enrollment

Based on the most recent information from CMS, provider Matthew Vaughn Edward Provost does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1073292512
Provider Type
Individual
Full Name
Provost, Matthew Vaughn Edward
Gender
Male

Sole Proprietor
No
Enumeration Date
7/12/2023
Last Updated
7/12/2023

Contact Information

Practice Location

1700 Airport Way S, Seattle, WA 98134-1618

Unlisted Fax

Mailing Location

1505 6th Ave S, Seattle, WA 98134-1630

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101Y00000X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer