Provider Demographics
NPI:1568105070
Name:MATA, ALEJANDRA (MA, LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3207
Mailing Address - Country:US
Mailing Address - Phone:214-450-2999
Mailing Address - Fax:
Practice Address - Street 1:3440 PARKWOOD BLVD.
Practice Address - Street 2:BUILDING D SUITE 401
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-989-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84431101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health