Healthcare Provider Details

I. General information

NPI: 1841119062
Provider Name (Legal Business Name): MATTHEW A SHANKS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 EAGLE RAY ST
LEANDER TX
78641-4112
US

IV. Provider business mailing address

1324 EAGLE RAY ST
LEANDER TX
78641-4112
US

V. Phone/Fax

Practice location:
  • Phone: 281-757-1492
  • Fax:
Mailing address:
  • Phone: 281-757-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: