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General NPI Number Information
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NPI Number | 1851580831
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Entity Type | Organization
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Legal Business Name | MCCULLOUGH VARGAS AND ASSOCIATES INC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 110 READING AVE
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City | JONESVILLE
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State | MI
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Zip | 49250-1136
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Country | US
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Telephone | 517-849-2330
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Fax | 517-849-2906
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Provider Business Mailing Address
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Address Line | 110 READING AVE
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City | JONESVILLE
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State | MI
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Zip | 49250-1136
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Country | US
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Telephone | 517-849-2330
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Fax | 517-849-2906
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GERALD N MCCULLOUGH
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Credential | MA, CAADC
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Telephone | 517-849-2330
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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 | 300027
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License Number State | MI
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