Active NPI
Candy Renae Mathis, LPC-ASSOCIATE
- Counselor
- Wichita Falls, TX
National Provider Identifier
1639929383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 90794
- Practice address
- 1505 8TH St
Wichita Falls, TX 76301-3106 - Phone
- (940) 322-3171
- NPI assigned
- Mar 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 90794 | TX | Primary |
Addresses
Primary practice location
1505 8TH St
Wichita Falls, TX 76301-3106
Mailing address
2202 Harrison St Apt 131
Wichita Falls, TX 76308-1328
Phone (940) 703-8227
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90794 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711324800000",
"number": "1639929383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2202 HARRISON ST APT 131",
"city": "WICHITA FALLS",
"state": "TX",
"postal_code": "763081328",
"telephone_number": "940-703-8227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 8TH ST",
"city": "WICHITA FALLS",
"state": "TX",
"postal_code": "763013106",
"telephone_number": "940-322-3171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "CANDY",
"middle_name": "RENAE",
"credential": "LPC-ASSOCIATE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-25",
"last_updated": "2024-03-25",
"certification_date": "2024-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "90794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita Falls, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.