Provider Demographics
NPI:1902674609
Name:SCHWARZ, MATTHEW (LCDC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SCHWARZ
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4004
Mailing Address - Country:US
Mailing Address - Phone:325-658-7750
Mailing Address - Fax:325-658-8381
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4842
Practice Address - Country:US
Practice Address - Phone:325-658-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)