Healthcare Provider Details

I. General information

NPI: 1033364724
Provider Name (Legal Business Name): MATTHEW CLEM MCGHEE MS, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 8TH ST
FORT SCOTT KS
66701-2404
US

IV. Provider business mailing address

103 W 23RD ST
PITTSBURG KS
66762-2832
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-8590
  • Fax:
Mailing address:
  • Phone: 620-231-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007025935
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC780
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: