Doctor Name: | DAVID REESE MCCULLOUGH |
NPI Number: | 1063590024 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 2410 |
Business Practice Address: | 2 N Water St Sapulpa, OK - 740662816 |
Business Phone Number: | 9182240225 |
Business Fax Number: | 9182245975 |
Mailing Address: | 2 N Water St, SAPULPA |
State: | OK |
Postal Code: | 740662816 |
Phone Number: | 9182240225 |
Fax Number: | 9182245975 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2410 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |