Individual
MATTHEW FRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CRC
Contact information
Practice address
2135 W RAMADA LN, CARBONDALE, IL 62901-5326
(618) 457-3318
(618) 549-0132
Mailing address
2135 W RAMADA LN, CARBONDALE, IL 62901-5326
(618) 457-3318
(618) 549-0132
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00112331
CRC
IL
Enumeration date
02/03/2012
Last updated
02/03/2012
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