MEDICARE: DR. LADORA ANN MATTHEWS PHD, LPC

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	81413	TX
4	101YP2500X	Professional Counselor
5	101YS0200X	School Counselor
6	101YP2500X	Professional Counselor	81413	TX

General Provider Information

NPI Number	:	1669048856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LADORA ANN MATTHEWS PHD, LPC

Provider Business Mailing Address
First Line	:	1306 55TH ST
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-4415
Country	:	US
Telephone Number	:	281-222-9174
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 WEST LOOP S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-4205
Country	:	US
Telephone Number	:	281-222-9174
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	08/12/2022

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