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General NPI Number Information
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NPI Number | 1457656357
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Entity Type | Individual
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Provider Name | LYNNE M MCCULLOCH OTR,MAC,LCAC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 6531 W WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-3026
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Country | US
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Telephone | 317-241-9644
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Fax | 317-241-9730
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Provider Business Mailing Address
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Address Line | 1138 S HIGH SCHOOL RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-3122
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Country | US
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Telephone | 317-241-9644
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Fax | 317-241-9730
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000236A
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License Number State | IN
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