Provider Demographics
NPI:1740051960
Name:MCCULLY, REX THOMAS II (LCSW)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:THOMAS
Last Name:MCCULLY
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 E DIVISION ST APT 804
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8311
Mailing Address - Country:US
Mailing Address - Phone:469-358-3311
Mailing Address - Fax:
Practice Address - Street 1:71 E DIVISION ST APT 804
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8311
Practice Address - Country:US
Practice Address - Phone:469-358-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical