MEDICARE: THE MCCULLOUGH CENTER FOR MENTAL HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	19585	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	909681	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1275790438	OTHER	GROUP NPI
6	1477521904	OTHER	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1275790438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MCCULLOUGH CENTER FOR MENTAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	2515 MCCULLOUGH AVE STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3585
Country	:	US
Telephone Number	:	210-736-1762
Fax Number	:	210-736-3156

Provider Business Practice Location Address
First Line	:	2515 MCCULLOUGH AVE STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3585
Country	:	US
Telephone Number	:	210-736-1762
Fax Number	:	210-736-3156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CEASAR GARZA
Credential	:	LPC
Telephone Number	:	210-736-1762

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	04/16/2025

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Directions to “THE MCCULLOUGH CENTER FOR MENTAL HEALTH SERVICES INC ” Practice Location

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