Provider Demographics
NPI:1114135324
Name:MATTHEWS, RACHEL MCCULLOUGH (DMIN, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MCCULLOUGH
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DMIN, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6812
Mailing Address - Country:US
Mailing Address - Phone:864-275-2495
Mailing Address - Fax:
Practice Address - Street 1:708 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6812
Practice Address - Country:US
Practice Address - Phone:864-275-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPCI #4985101YP1600X
NCASSOCIATE #66101YP1600X
SCLPC 5356101YP1600X, 101YP2500X
IL180.012879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional