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General NPI Number Information
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NPI Number | 1538530191
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Entity Type | Individual
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Provider Name | MATTHEW PETER LESSACK M.A.
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Gender | Male
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 814 MICHIGAN AVE APT 2W
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City | EVANSTON
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State | IL
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Zip | 60202-2544
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Country | US
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Telephone | 224-259-2271
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Fax | 833-806-2514
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Provider Business Mailing Address
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Address Line | PO BOX 6032
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City | EVANSTON
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State | IL
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Zip | 60204-6032
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Country | US
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Telephone | 224-259-2271
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Fax | 833-806-2514
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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