Healthcare Provider Details

I. General information

NPI: 1629991286
Provider Name (Legal Business Name): BRITTANY ANN MCCULLOCH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAKEWOOD CIR STE A104
COLORADO SPRINGS CO
80910-2667
US

IV. Provider business mailing address

411 LAKEWOOD CIR STE A104
COLORADO SPRINGS CO
80910-2667
US

V. Phone/Fax

Practice location:
  • Phone: 719-302-3175
  • Fax: 855-832-8321
Mailing address:
  • Phone: 719-302-3175
  • Fax: 855-832-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: