Provider Demographics
NPI:1144425463
Name:MCNULTY CONSULTANTS, INC
Entity Type:Organization
Organization Name:MCNULTY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-673-5510
Mailing Address - Street 1:1N270 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3543
Mailing Address - Country:US
Mailing Address - Phone:630-673-5510
Mailing Address - Fax:
Practice Address - Street 1:125 E LAKE ST STE 206
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1117
Practice Address - Country:US
Practice Address - Phone:630-673-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490043381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02222710OtherBLUE CROSS BLUE SHIELD ID
IL02222710OtherBLUE CROSS BLUE SHIELD ID
IL02222710OtherBLUE CROSS BLUE SHIELD ID