Provider Demographics
NPI:1306578190
Name:CARRILLO, MATTHEW PADEN (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PADEN
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:PADEN
Other - Last Name:TRIETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:5900 MEMORIAL DR STE 218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8008
Mailing Address - Country:US
Mailing Address - Phone:512-591-8510
Mailing Address - Fax:713-554-2251
Practice Address - Street 1:5900 MEMORIAL DR STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8008
Practice Address - Country:US
Practice Address - Phone:512-591-8510
Practice Address - Fax:713-554-2251
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89105101Y00000X, 101YP2500X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty