Healthcare Provider Details

I. General information

NPI: 1770035578
Provider Name (Legal Business Name): MCCULLOUGH, VARGAS, & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 READING AVE
JONESVILLE MI
49250-0000
US

IV. Provider business mailing address

770 RIVERSIDE AVE
ADRIAN MI
49221-1476
US

V. Phone/Fax

Practice location:
  • Phone: 517-264-2244
  • Fax:
Mailing address:
  • Phone: 517-264-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number101YA0400X
License Number StateMI

VIII. Authorized Official

Name: GERALD MCCULLOUGH
Title or Position: EXCEUTIVE DIRECTOR
Credential: MA, CAADC
Phone: 517-264-2244