Alexa Matthies

Individual provider Active NPI Mental Health Counselor · Sullivan, IL

NPI 1417640947 · NPPES record last updated May 31, 2023

Key facts

NPI
1417640947
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
12 W Harrison St
Sullivan, IL 61951-1907
Phone
(217) 728-4358
NPI assigned
May 31, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Moultrie County Mental Health Center Mental Health Current
since Jun 4, 2023
Accepting new patients

Locations

12 W Harrison St
Sullivan, IL 61951
Phone (217) 728-4358

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Yes

Addresses

Primary practice location

12 W Harrison St
Sullivan, IL 61951-1907

Mailing address

12 W Harrison St
Sullivan, IL 61951-1907

Other providers in Sullivan, IL

All providers in Sullivan, IL · Mental Health Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.