Provider Demographics
NPI:1740656016
Name:MATHY HOUSE COUNSELING CENTER
Entity type:Organization
Organization Name:MATHY HOUSE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-621-3014
Mailing Address - Street 1:2408 N NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7017
Mailing Address - Country:US
Mailing Address - Phone:217-621-3014
Mailing Address - Fax:
Practice Address - Street 1:404 W GREEN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3267
Practice Address - Country:US
Practice Address - Phone:217-621-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0127141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty