Doctor Name: | BRIAN PATRICK MCCULLOUGH |
NPI Number: | 1417244716 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPCC |
License Number: | 310 |
Business Practice Address: | 2240 Ridge Dr Mailbox #9 Saint Louis Park, MN - 554165627 |
Business Phone Number: | 6122753740 |
Business Fax Number: | |
Mailing Address: | 2240 Ridge Dr, Mailbox #9 SAINT LOUIS PARK |
State: | MN |
Postal Code: | 554165627 |
Phone Number: | 6122753740 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2011 |
NPI Last Update Date: | 07/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 310 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |