Provider Demographics
NPI:1740527522
Name:MATHY, MAURICE (LPC)
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:MATHY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4537
Mailing Address - Country:US
Mailing Address - Phone:630-290-4742
Mailing Address - Fax:
Practice Address - Street 1:544 S CORNELL AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2948
Practice Address - Country:US
Practice Address - Phone:630-993-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional