Healthcare Provider Details

I. General information

NPI: 1649062894
Provider Name (Legal Business Name): MATTHEW J WILMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 70
LE MARS IA
51031-0070
US

IV. Provider business mailing address

4317 FIELDCREST DR APT 1A
SIOUX CITY IA
51103-5720
US

V. Phone/Fax

Practice location:
  • Phone: 712-966-2081
  • Fax:
Mailing address:
  • Phone: 712-899-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138666
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25049
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: