Provider Demographics
NPI:1396311031
Name:MATHIS, NATANIA EVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:NATANIA
Middle Name:EVETTE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NATANIA
Other - Middle Name:EVETTE
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:909 CARDIFF
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3969
Mailing Address - Country:US
Mailing Address - Phone:210-907-0398
Mailing Address - Fax:
Practice Address - Street 1:909 CARDIFF
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3969
Practice Address - Country:US
Practice Address - Phone:210-907-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health