Provider Demographics
NPI:1295972511
Name:MCCREARY, MATTHEW J (LPC, CADC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:MCCREARY
Suffix:
Gender:M
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W GORDON TER
Mailing Address - Street 2:APT 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2274
Mailing Address - Country:US
Mailing Address - Phone:312-480-5022
Mailing Address - Fax:
Practice Address - Street 1:711 W GORDON TER
Practice Address - Street 2:APT 512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2274
Practice Address - Country:US
Practice Address - Phone:312-480-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional