Provider Demographics
NPI:1235939190
Name:MATLOCK, SAVANNAH (LMSW)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:MATLOCK
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 S LAKELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3872
Mailing Address - Country:US
Mailing Address - Phone:210-831-4822
Mailing Address - Fax:512-617-9540
Practice Address - Street 1:1860 S LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3872
Practice Address - Country:US
Practice Address - Phone:210-831-4822
Practice Address - Fax:512-617-9540
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570151041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical