Organization Name: | DAVID E MATTHEWS |
NPI Number: | 1164451902 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID E MATTHEWS (OWNER/DIRECTOR) |
Mailing Address: | 109 Lou Ann Dr Herrin |
State: | IL US |
Postal Code: | 629483733 |
Phone Number: | 6189881330 |
Fax Number: | 6189888321 |
NPI Enumeration Date: | 07/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |