Healthcare Provider Details

I. General information

NPI: 1316237530
Provider Name (Legal Business Name): MATHERS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S VIRGINIA ST
CRYSTAL LAKE IL
60014-7226
US

IV. Provider business mailing address

145 S VIRGINIA ST
CRYSTAL LAKE IL
60014-7226
US

V. Phone/Fax

Practice location:
  • Phone: 815-444-9999
  • Fax: 815-356-6680
Mailing address:
  • Phone: 815-444-9999
  • Fax: 815-986-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number36039266
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36039266
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT MEYER
Title or Position: OWNER
Credential:
Phone: 815-444-9999