Provider Demographics
NPI:1124280938
Name:MULSO, NANCY E (LCPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:MULSO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1722
Mailing Address - Country:US
Mailing Address - Phone:847-364-7974
Mailing Address - Fax:
Practice Address - Street 1:626 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1722
Practice Address - Country:US
Practice Address - Phone:847-364-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional