MEDICARE: MR. MARVIN S. MATHEWS LMFT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor		MD
4	106H00000X	Marriage & Family Therapist	003490	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00153B	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1619900933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARVIN S. MATHEWS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 120874
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-0874
Country	:	US
Telephone Number	:	877-521-7927
Fax Number	:	817-719-0334

Provider Business Practice Location Address
First Line	:	1506 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	877-521-7927
Fax Number	:	817-719-0334

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/11/2025

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