Provider Demographics
NPI:1245713056
Name:MATHEWES, ALEXANDRA BROOKE (MED, LCPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BROOKE
Last Name:MATHEWES
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 W CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4602
Mailing Address - Country:US
Mailing Address - Phone:177-337-2458
Mailing Address - Fax:
Practice Address - Street 1:650 N DEARBORN ST STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5358
Practice Address - Country:US
Practice Address - Phone:177-337-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional