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General NPI Number Information
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NPI Number | 1780442574
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Entity Type | Individual
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Provider Name | MATTHEW FORD PEL
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Gender | Male
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 81 S MCLEAN BLVD
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1859
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Country | US
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Telephone | 630-596-3688
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 LUCILLE LN
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City | HANOVER PARK
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State | IL
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Zip | 60133-5352
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Country | US
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Telephone | 630-337-1486
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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 | 2385570
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License Number State | IL
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