Provider Demographics
NPI:1588285605
Name:MATTHEWS, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TX
Mailing Address - Zip Code:78011-0071
Mailing Address - Country:US
Mailing Address - Phone:210-382-0059
Mailing Address - Fax:
Practice Address - Street 1:5345 W FM 140
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-4978
Practice Address - Country:US
Practice Address - Phone:210-382-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional