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General NPI Number Information
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NPI Number | 1780208959
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Entity Type | Individual
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Provider Name | BRIAN THOMAS MCCULLOUGH PMHNP
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Gender | Male
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 34225 N 27TH DR STE 140
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City | PHOENIX
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State | AZ
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Zip | 85085-6090
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Country | US
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Telephone | 602-492-3692
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Fax | 602-698-9668
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Provider Business Mailing Address
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Address Line | 34225 N 27TH DR STE 140
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City | PHOENIX
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State | AZ
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Zip | 85085-6090
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Country | US
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Telephone | 602-492-3692
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Fax | 602-698-9668
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 241813
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License Number State | AZ
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