Provider Demographics
NPI:1609363803
Name:HULLINGER, TEGAN (MAED, LCPC)
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:
Last Name:HULLINGER
Suffix:
Gender:F
Credentials:MAED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W AUGUSTA BLVD APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3207
Mailing Address - Country:US
Mailing Address - Phone:480-635-2870
Mailing Address - Fax:
Practice Address - Street 1:5340 N CLARK ST STE 212
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2120
Practice Address - Country:US
Practice Address - Phone:773-750-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health