MEDICARE: JAIMIE LEIGH MATHEWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	203642	TX

General Provider Information

NPI Number	:	1245854496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMIE LEIGH MATHEWS

Provider Business Mailing Address
First Line	:	3334 SSW LOOP 323 STE 114
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-9237
Country	:	US
Telephone Number	:	903-343-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	3334 SSW LOOP 323 STE 114
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-9237
Country	:	US
Telephone Number	:	903-343-6215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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Directions to “ JAIMIE LEIGH MATHEWS ” Practice Location

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