Provider Demographics
NPI:1528142957
Name:KULLMAN, MARY (MS, LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KULLMAN
Suffix:
Gender:F
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 1:1112 S WASHINGTON ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7959
Mailing Address - Country:US
Mailing Address - Phone:630-983-4577
Mailing Address - Fax:630-983-4690
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:630-983-4577
Practice Address - Fax:630-983-4690
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health