Provider Demographics
NPI:1104560036
Name:MATTHEW MARX THERAPY, PLLC
Entity type:Organization
Organization Name:MATTHEW MARX THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:920-221-9691
Mailing Address - Street 1:1509 OAK AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4263
Mailing Address - Country:US
Mailing Address - Phone:920-221-9691
Mailing Address - Fax:
Practice Address - Street 1:1509 OAK AVE APT 3N
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4263
Practice Address - Country:US
Practice Address - Phone:920-221-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health