Healthcare Provider Details

I. General information

NPI: 1760152995
Provider Name (Legal Business Name): ANNA KULTYS, LCPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 N LINCOLN AVE STE 204
CHICAGO IL
60614-2422
US

IV. Provider business mailing address

2451 N LINCOLN AVE STE 204
CHICAGO IL
60614-2422
US

V. Phone/Fax

Practice location:
  • Phone: 312-646-8937
  • Fax:
Mailing address:
  • Phone: 312-646-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA E KULTYS
Title or Position: MANAGING OFFICER
Credential: LCPC
Phone: 312-646-8937