Provider Demographics
NPI:1487987301
Name:MATHEWSON, MARLENE RUTH (LPC,LMFT)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:RUTH
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 FOURWINDS DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1970
Mailing Address - Country:US
Mailing Address - Phone:210-590-0377
Mailing Address - Fax:210-590-0381
Practice Address - Street 1:8930 FOURWINDS DR
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-1970
Practice Address - Country:US
Practice Address - Phone:210-590-0377
Practice Address - Fax:210-590-0381
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15757101YP2500X
TX4813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist