Provider Demographics
NPI:1871841981
Name:DAVIS, MATTHEW M (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 RIDGECREST CIR STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5498
Mailing Address - Country:US
Mailing Address - Phone:806-803-5013
Mailing Address - Fax:806-553-1312
Practice Address - Street 1:4231 RIDGECREST CIR STE B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5498
Practice Address - Country:US
Practice Address - Phone:806-803-5013
Practice Address - Fax:806-553-1312
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional