Basic Information
| Provider Information | |||||||||
| NPI: | 1306425509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIFFIN | ||||||||
| FirstName: | MATHEW | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2924 W SHAKESPEARE AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606471486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139675210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 N MICHIGAN AVE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128159660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 178016863 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.