Healthcare Provider Details

I. General information

NPI: 1003308008
Provider Name (Legal Business Name): ANN SYLVIA MATUS LCPC, CADC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 12/28/2023
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEXINGTON DR STE 150
BUFFALO GROVE IL
60089-6939
US

IV. Provider business mailing address

3436 N KENNICOTT AVE
ARLINGTON HTS IL
60004-7814
US

V. Phone/Fax

Practice location:
  • Phone: 224-434-2855
  • Fax: 847-342-0378
Mailing address:
  • Phone: 847-952-7460
  • Fax: 847-222-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015356
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-55537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: