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General NPI Number Information
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NPI Number | 1487566824
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Entity Type | Individual
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Provider Name | JACKSON MULLEN
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Gender | Male
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 725 E DUNDEE RD STE 202
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-1538
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Country | US
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Telephone | 312-324-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-1928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.033457
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License Number State | IL
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