Provider Demographics
NPI:1851271027
Name:MATTI, GWENEVERE
Entity type:Individual
Prefix:
First Name:GWENEVERE
Middle Name:
Last Name:MATTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 NORTHAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7618
Mailing Address - Country:US
Mailing Address - Phone:713-800-6999
Mailing Address - Fax:
Practice Address - Street 1:6823 NORTHAMPTON WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7618
Practice Address - Country:US
Practice Address - Phone:713-800-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist