Healthcare Provider Details

I. General information

NPI: 1629255765
Provider Name (Legal Business Name): KAREN S. MCCULLOUGH-THOMAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN S. MCCULLOUGH

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

IV. Provider business mailing address

477 GLENDALE RD
BUFFALO GROVE IL
60089-3511
US

V. Phone/Fax

Practice location:
  • Phone: 847-467-7423
  • Fax:
Mailing address:
  • Phone: 847-537-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: