Doctor Name: | MS. SUSAN E MCCULLEY |
NPI Number: | 1003800210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED., LPC |
License Number: | 9436 |
Business Practice Address: | 459 W Houston St Jasper, TX - 759513510 |
Business Phone Number: | 4093842340 |
Business Fax Number: | 4093848060 |
Mailing Address: | 501 Mantooth Ave, LUFKIN |
State: | TX |
Postal Code: | 759043014 |
Phone Number: | 9366394993 |
Fax Number: | 9366396838 |
NPI Enumeration Date: | 09/01/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 9436 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |