=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851271027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GWENEVERE MATTI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2025
-----------------------------------------------------
Last Update Date | 09/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6823 NORTHAMPTON WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-7618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-800-6999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6823 NORTHAMPTON WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-7618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-800-6999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 205722
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------