Provider Demographics
NPI:1013639699
Name:MATTHEW M DAVIS PLLC
Entity Type:Organization
Organization Name:MATTHEW M DAVIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:806-803-5013
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303185801Medicaid