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General NPI Number Information
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NPI Number | 1396626438
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL BARRY
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Gender | Male
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 200 WASHINGTON ST
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City | WEST DUNDEE
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State | IL
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Zip | 60118-1275
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Country | US
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Telephone | 815-382-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 966 LONGFORD CT
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City | BARTLETT
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State | IL
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Zip | 60103-1954
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Country | US
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Telephone | 847-454-5481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178021995
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License Number State | IL
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