Provider Demographics
NPI:1437993771
Name:MATTHEWS, ANGELICA TIBECA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:TIBECA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 DUANE DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-1929
Mailing Address - Country:US
Mailing Address - Phone:915-974-0043
Mailing Address - Fax:
Practice Address - Street 1:600 W 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3684
Practice Address - Country:US
Practice Address - Phone:682-258-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPRE-LICENSE101Y00000X
TXPRE-LICENSED101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor