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General NPI Number Information
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NPI Number | 1730454992
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Entity Type | Organization
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Legal Business Name | MCCULLOUGH CONSULTANTS LLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 8826 S GRAMERCY PL
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City | LOS ANGELES
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State | CA
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Zip | 90047-3205
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Country | US
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Telephone | 323-691-1859
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Fax |
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Provider Business Mailing Address
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Address Line | 8826 S GRAMERCY PL
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City | LOS ANGELES
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State | CA
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Zip | 90047-3205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADIA MCCULLOUGH
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Credential |
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Telephone | 323-691-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17498
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License Number State | CA
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