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General NPI Number Information
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NPI Number | 1083654974
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Entity Type | Individual
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Provider Name | JUDY PRICER MATHEA LPC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 801 A KENNEDALE SUBLETT RD
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City | KENNEDALE
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State | TX
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Zip | 76060
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Country | US
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Telephone | 817-483-0020
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Fax | 817-572-6676
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Provider Business Mailing Address
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Address Line | 6616 ST. JOHNS DR. APT. 1002
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City | FORT WORTH
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State | TX
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Zip | 76132-2716
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Country | US
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Telephone | 817-891-3268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13419
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC13419
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License Number State | TX
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