MEDICARE: TEGAN HULLINGER MAED, LCPC

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	180.011422	IL

General Provider Information

NPI Number	:	1609363803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEGAN HULLINGER MAED, LCPC

Provider Business Mailing Address
First Line	:	1707 W AUGUSTA BLVD APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3207
Country	:	US
Telephone Number	:	480-635-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	5340 N CLARK ST STE 212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2120
Country	:	US
Telephone Number	:	773-750-3505
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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