Provider Demographics
NPI:1184788671
Name:MCMULLIN, PAMELA JEAN (PSYD LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:PSYD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARGER RD
Mailing Address - Street 2:STE 600
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1820
Mailing Address - Country:US
Mailing Address - Phone:630-571-5750
Mailing Address - Fax:630-571-5751
Practice Address - Street 1:1200 HARGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1820
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:630-571-5751
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical