Healthcare Provider Details

I. General information

NPI: 1528911047
Provider Name (Legal Business Name): MATTHEW CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 WASHINGTON ST FL 2
DOWNERS GROVE IL
60515-4701
US

IV. Provider business mailing address

1934 N WASHTENAW AVE APT 205
CHICAGO IL
60647-7132
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-6710
  • Fax:
Mailing address:
  • Phone: 415-215-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: