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General NPI Number Information
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NPI Number | 1316237530
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Entity Type | Organization
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Legal Business Name | MATHERS CLINIC LLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 145 S VIRGINIA ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7226
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Country | US
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Telephone | 815-444-9999
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Fax | 815-356-6680
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Provider Business Mailing Address
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Address Line | 145 S VIRGINIA ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7226
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Country | US
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Telephone | 815-444-9999
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Fax | 815-986-1363
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MEYER
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Credential |
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Telephone | 815-444-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 36039266
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 36039266
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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