Provider Demographics
NPI:1174137251
Name:MULLEN, ANNE CARTER (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CARTER
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6184
Mailing Address - Country:US
Mailing Address - Phone:847-922-3324
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6184
Practice Address - Country:US
Practice Address - Phone:847-922-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional