MEDICARE: DR. MARK WALKER MATTHEWS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	31431	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609090471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WALKER MATTHEWS PHD

Provider Business Mailing Address
First Line	:	8017 CRAZY HORSE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4161
Country	:	US
Telephone Number	:	817-909-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	8017 CRAZY HORSE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4161
Country	:	US
Telephone Number	:	817-577-5717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/27/2022

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