Provider Demographics
NPI:1902185929
Name:MATHEWS, CATHERINE C (EDS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24126 FOSTERS KNOLL LANE
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365
Mailing Address - Country:US
Mailing Address - Phone:850-322-8673
Mailing Address - Fax:
Practice Address - Street 1:24126 FOSTERS KNOLL LN
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-8812
Practice Address - Country:US
Practice Address - Phone:850-322-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35220103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool