MEDICARE: MS. MICHELLE MARIE MCMULLIN L.C.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180-000880	IL

General Provider Information

NPI Number	:	1467628214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MARIE MCMULLIN L.C.P.C.

Provider Business Mailing Address
First Line	:	1230 N HIGHLAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-1401
Country	:	US
Telephone Number	:	630-966-4308
Fax Number	:	630-859-2994

Provider Business Practice Location Address
First Line	:	1230 N HIGHLAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-1401
Country	:	US
Telephone Number	:	630-966-4308
Fax Number	:	630-859-2994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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