Provider Demographics
NPI:1497365761
Name:MATHEW, ASHA ALEXANDER
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:ALEXANDER
Last Name:MATHEW
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 1:15825 WYOMING DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6699
Mailing Address - Country:US
Mailing Address - Phone:214-554-3697
Mailing Address - Fax:
Practice Address - Street 1:15825 WYOMING DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6699
Practice Address - Country:US
Practice Address - Phone:214-554-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty