Provider Demographics
NPI:1619584893
Name:MATTHEWS, CAMILLE D (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:D
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LCSW
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 813
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-0813
Mailing Address - Country:US
Mailing Address - Phone:972-584-7657
Mailing Address - Fax:
Practice Address - Street 1:5005 COLLEYVILLE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6131
Practice Address - Country:US
Practice Address - Phone:972-584-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical