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General NPI Number Information
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NPI Number | 1770035578
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Entity Type | Organization
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Legal Business Name | MCCULLOUGH, VARGAS, & ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 101 READING AVE
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City | JONESVILLE
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State | MI
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Zip | 49250-0000
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Country | US
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Telephone | 517-264-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 770 RIVERSIDE AVE
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City | ADRIAN
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State | MI
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Zip | 49221-1476
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Country | US
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Telephone | 517-264-2244
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Fax |
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Authorized Official
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Title or Position | EXCEUTIVE DIRECTOR
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Name | GERALD MCCULLOUGH
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Credential | MA, CAADC
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Telephone | 517-264-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 101YA0400X
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License Number State | MI
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