Provider Demographics
NPI:1750720512
Name:GULLO, CINDY J (LCPC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:GULLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1757
Mailing Address - Country:US
Mailing Address - Phone:618-806-9507
Mailing Address - Fax:618-206-6020
Practice Address - Street 1:1218 PARAGON DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1757
Practice Address - Country:US
Practice Address - Phone:618-806-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional