Healthcare Provider Details

I. General information

NPI: 1902918022
Provider Name (Legal Business Name): TIM CULLITAN LCPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 E ELM ST APT 9A
CHICAGO IL
60611-5240
US

IV. Provider business mailing address

73 E ELM ST APT 9A
CHICAGO IL
60611-5240
US

V. Phone/Fax

Practice location:
  • Phone: 847-340-4461
  • Fax:
Mailing address:
  • Phone: 847-340-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180002376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: