Provider Demographics
NPI:1982094785
Name:NGWA, MATHIAS (PSYD, LPA, ABSNP)
Entity Type:Individual
Prefix:DR
First Name:MATHIAS
Middle Name:
Last Name:NGWA
Suffix:
Gender:M
Credentials:PSYD, LPA, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 KITTERY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4177
Mailing Address - Country:US
Mailing Address - Phone:682-234-2561
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD STE 228
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:682-321-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical