Provider Demographics
NPI:1558884734
Name:MATTISON, THOMAS LLOYD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LLOYD
Last Name:MATTISON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 W BERTEAU AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1310
Mailing Address - Country:US
Mailing Address - Phone:847-323-6606
Mailing Address - Fax:
Practice Address - Street 1:5430 W BERTEAU AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1310
Practice Address - Country:US
Practice Address - Phone:847-323-6606
Practice Address - Fax:847-323-6606
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0194981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty