Healthcare Provider Details

I. General information

NPI: 1205772456
Provider Name (Legal Business Name): LANEA MARIE MATTHEWS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 MOTLEY DR
FORT WORTH TX
76179-1692
US

IV. Provider business mailing address

9709 MOTLEY DR
FORT WORTH TX
76179-1692
US

V. Phone/Fax

Practice location:
  • Phone: 509-855-6184
  • Fax:
Mailing address:
  • Phone: 509-855-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97956
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: