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NPI Code Detail

MEDICARE: JEFFREY MCCULLOUGH

MEDICARE:   JEFFREY  MCCULLOUGH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1609213008
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY MCCULLOUGH
Provider Business Mailing Address
First Line : 3208 E 20TH AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99223-5402
Country : US
Telephone Number : 509-951-5672
Fax Number :
Provider Business Practice Location Address
First Line : 901 N MONROE ST STE 200
Second Line :
City : SPOKANE
State : WA
Zip : 99201-2148
Country : US
Telephone Number : 509-328-2740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2013
Last Update Date : 05/28/2013

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Directions to “ JEFFREY MCCULLOUGH ” Practice Location

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