Healthcare Provider Details

I. General information

NPI: 1659368157
Provider Name (Legal Business Name): JOAN E. MCCULLOUGH-CRISSMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN E. MCCULLOUGH LPC

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 WILLIAM PENN HWY
MURRYSVILLE PA
15668-2002
US

IV. Provider business mailing address

189 TOLLGATE HILL RD
GREENSBURG PA
15601-6206
US

V. Phone/Fax

Practice location:
  • Phone: 724-972-6409
  • Fax: 724-519-8463
Mailing address:
  • Phone: 724-972-6409
  • Fax: 724-519-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: