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Individual
MARY B MATTIS
Active
Individual
MARY B MATTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12038
TX
1041C0700X
Clinical Social Worker
Primary
53118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12020270
CAHQ
TX
05
—
210099201
—
TX
Enumeration date
05/01/2007
Last updated
03/30/2013
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