Provider Demographics
NPI:1073134359
Name:MATTHEW, FELICIA LYNETTE (LPC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LYNETTE
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6958 HUNNICUT CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-2943
Mailing Address - Country:US
Mailing Address - Phone:214-336-5566
Mailing Address - Fax:
Practice Address - Street 1:10440 N CENTRAL EXPY # 833
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2221
Practice Address - Country:US
Practice Address - Phone:214-702-6782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional