MEDICARE: JAYA MATHEW PHD, PLLC

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	103T00000X	Psychologist	36584	TX

General Provider Information

NPI Number	:	1902332240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYA MATHEW PHD, PLLC

Provider Business Mailing Address
First Line	:	1340 PRUDENTIAL DR
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:	214-755-7532
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 PRUDENTIAL DR
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:	214-755-7532
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAYA MATHEW
Credential	:	PH.D.
Telephone Number	:	214-755-7532

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	05/05/2017

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