Healthcare Provider Details

I. General information

NPI: 1972098408
Provider Name (Legal Business Name): GREG JAMES KULIK LCPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 THOMPSON AVE
WINTHROP HARBOR IL
60096-1152
US

IV. Provider business mailing address

132 THOMPSON AVE
WINTHROP HARBOR IL
60096-1152
US

V. Phone/Fax

Practice location:
  • Phone: 872-203-3640
  • Fax:
Mailing address:
  • Phone: 872-203-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: