Provider Demographics
NPI:1639929383
Name:MATHIS, CANDY RENAE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:RENAE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 HARRISON ST APT 131
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1328
Mailing Address - Country:US
Mailing Address - Phone:940-703-8227
Mailing Address - Fax:
Practice Address - Street 1:1505 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3106
Practice Address - Country:US
Practice Address - Phone:940-322-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90794101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor