Basic Information
| Provider Information | |||||||||
| NPI: | 1962041178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPIKES | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | WARREN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8002 SAINT FILLANS LN | ||||||||
| Address2: | |||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750897861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063927921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1350 N WESTMORELAND RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143300036 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 78959 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.