MEDICARE: MR. MATTHEW CLEM MCGHEE MS, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2007025935	MO
2	101YP2500X	Professional Counselor	LCPC780	KS

General Provider Information

NPI Number	:	1033364724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW CLEM MCGHEE MS, LCPC

Provider Business Mailing Address
First Line	:	103 W 23RD ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-2832
Country	:	US
Telephone Number	:	620-231-1708
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 W 8TH ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-2404
Country	:	US
Telephone Number	:	620-223-8590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	08/10/2010

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