Provider Demographics
NPI:1164451902
Name:DAVID E MATTHEWS
Entity Type:Organization
Organization Name:DAVID E MATTHEWS
Other - Org Name:MATTHEWS AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:618-988-1330
Mailing Address - Street 1:109 LOU ANN DR
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3733
Mailing Address - Country:US
Mailing Address - Phone:618-988-1330
Mailing Address - Fax:618-988-8321
Practice Address - Street 1:109 LOU ANN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3733
Practice Address - Country:US
Practice Address - Phone:618-988-1330
Practice Address - Fax:618-988-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211368Medicare ID - Type Unspecified