Provider Demographics
NPI:1821272808
Name:MATEO, NICOLE (LPC-S)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MATEO
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FLECHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11223 SCARLET OAK LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7781
Mailing Address - Country:US
Mailing Address - Phone:817-323-7285
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD BLDG 13-400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7228
Practice Address - Country:US
Practice Address - Phone:770-896-2659
Practice Address - Fax:470-428-8144
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6096101YP2500X
TX68091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX891LPROtherBLUE CROSS BLUE SHIELD
TX281842907Medicaid