Provider Demographics
NPI:1154881233
Name:CASTON, MATTHEW N JR (LCPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:N
Last Name:CASTON
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 E 166TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2401
Mailing Address - Country:US
Mailing Address - Phone:312-852-4613
Mailing Address - Fax:
Practice Address - Street 1:847 E 166TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2401
Practice Address - Country:US
Practice Address - Phone:312-852-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013059101YM0800X
IL180.013246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health