Individual
TYHILYA KUNISHA MCCULLUM-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2844 GRAND BLVD, HIGHLAND, IN 46322-1238
(309) 634-6118
Mailing address
9721 165TH ST STE 21, ORLAND PARK, IL 60467-4511
(708) 671-8946
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
178006611
IL
101YM0800X
Mental Health Counselor
178006611
IL
101YP2500X
Professional Counselor
Primary
180-007578
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-0934175
BRIDGEWAY FEIN
IL
Enumeration date
07/16/2010
Last updated
01/27/2023
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