Provider Demographics
NPI:1386966372
Name:MATTHEWS, AMY E (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2891
Mailing Address - Country:US
Mailing Address - Phone:773-516-3134
Mailing Address - Fax:773-516-3134
Practice Address - Street 1:12 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510
Practice Address - Country:US
Practice Address - Phone:773-516-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26021101YA0400X
IL180.007316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.007316OtherLCPC-STATE LICENSED CLINICAL PROFESSIONAL COUNSELOR
219970OtherNCC-NATIONAL CERTIFIED COUNSELOR
IL26021OtherCADC--STATE CERTIFIED ALCOHOL AND DRUG COUNSELOR LICENSE