Provider Demographics
NPI:1386912335
Name:MYER, MATTHEW GERARD (LCPC, NCC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GERARD
Last Name:MYER
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 W SHERWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1254
Mailing Address - Country:US
Mailing Address - Phone:773-558-0241
Mailing Address - Fax:773-775-6246
Practice Address - Street 1:4305 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1711
Practice Address - Country:US
Practice Address - Phone:773-558-0241
Practice Address - Fax:773-775-6246
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.003397OtherSTATE OF ILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION: LICENSED PROFES
IL180.003397OtherSTATE OF ILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION: LICENSED PROFES