Healthcare Provider Details

I. General information

NPI: 1336632363
Provider Name (Legal Business Name): JOYCE MCCULLEN LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 N LAMAR BLVD STE D109
AUSTIN TX
78752-1036
US

IV. Provider business mailing address

7801 NORTH LAMAR BOULEVARD D-109
AUSTIN TX
78752
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-8180
  • Fax: 512-454-7441
Mailing address:
  • Phone: 512-454-8180
  • Fax: 512-454-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: