Provider Demographics
NPI:1396870929
Name:TRAMMELL, MATHEW A (LPC-S)
Entity type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:A
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4535
Mailing Address - Country:US
Mailing Address - Phone:817-301-6322
Mailing Address - Fax:
Practice Address - Street 1:2630 WEST FWY STE 220
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-7118
Practice Address - Country:US
Practice Address - Phone:817-301-6322
Practice Address - Fax:817-887-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional