Provider Demographics
NPI:1962057448
Name:MATHIS, PAUL DAVID (LPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:MATHIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5653
Mailing Address - Country:US
Mailing Address - Phone:325-673-6489
Mailing Address - Fax:325-673-1794
Practice Address - Street 1:150 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5653
Practice Address - Country:US
Practice Address - Phone:325-673-6489
Practice Address - Fax:325-673-1794
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional