Healthcare Provider Details

I. General information

NPI: 1255120366
Provider Name (Legal Business Name): MATTHEW BENTON MAKEEVER MA, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

408 W MAIN ST
OTTAWA IL
61350-2802
US

IV. Provider business mailing address

434 CONGRESS ST
OTTAWA IL
61350-3014
US

V. Phone/Fax

Practice location:
  • Phone: 815-326-9502
  • Fax: 815-324-5102
Mailing address:
  • Phone: 815-252-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: