Provider Demographics
NPI:1003359340
Name:MULSO ASSOCIATES COUNSELING, LTD
Entity Type:Organization
Organization Name:MULSO ASSOCIATES COUNSELING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-338-6101
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 138S
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:847-338-6101
Mailing Address - Fax:847-364-7974
Practice Address - Street 1:2625 BUTTERFIELD RD
Practice Address - Street 2:SUITE 138S
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1234
Practice Address - Country:US
Practice Address - Phone:847-338-6101
Practice Address - Fax:847-364-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325466306001Medicaid