Healthcare Provider Details

I. General information

NPI: 1497293104
Provider Name (Legal Business Name): ANDREW PAUL MATTERN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17070 RED OAK DR STE 209
HOUSTON TX
77090-2615
US

IV. Provider business mailing address

17070 RED OAK DR STE 209
HOUSTON TX
77090-2615
US

V. Phone/Fax

Practice location:
  • Phone: 832-225-3345
  • Fax: 713-583-1504
Mailing address:
  • Phone: 832-225-3345
  • Fax: 713-583-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75864
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: