Healthcare Provider Details

I. General information

NPI: 1821911660
Provider Name (Legal Business Name): RILEY MCCULLOUGH LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E CHESTNUT EXPY STE 800
SPRINGFIELD MO
65802-6311
US

IV. Provider business mailing address

3003 E CHESTNUT EXPY STE 800
SPRINGFIELD MO
65802-6311
US

V. Phone/Fax

Practice location:
  • Phone: 417-268-0207
  • Fax:
Mailing address:
  • Phone: 417-268-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026032127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: