Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 180.012879 | IL |
N | 101YP1600X | Pastoral Counselor | ASSOCIATE #66 | NC |
N | 101YP1600X | Pastoral Counselor | LPC 5356 | SC |
N | 101YP1600X | Pastoral Counselor | LPCI #4985 | SC |
N | 101YP2500X | Professional Counselor | LPC 5356 | SC |
NPI | 1114135324 |
---|---|
Provider Name | Rachel Mccullough Matthews |
First Address | Champaign, IL 61820-6812 |
Second Address | Champaign, IL 61820-6812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 30/10/2020 |