Provider Demographics
NPI:1871685115
Name:HUNT, MATTHEW WAYNE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WAYNE
Last Name:HUNT
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1391
Mailing Address - Country:US
Mailing Address - Phone:217-872-1700
Mailing Address - Fax:217-872-1366
Practice Address - Street 1:3040 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1391
Practice Address - Country:US
Practice Address - Phone:217-872-1700
Practice Address - Fax:217-872-1366
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0035840188OtherBLUE CROSS/BLUE SHIELD