MEDICARE: MR. ROBERT E MCCULLOUGH II LMHC, SUDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00004280	WA
2	101YM0800X	Mental Health Counselor	LH61367968	WA

General Provider Information

NPI Number	:	1386006922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT E MCCULLOUGH II LMHC, SUDP

Provider Business Mailing Address
First Line	:	809 W MAIN ST STE C
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2172
Country	:	US
Telephone Number	:	206-552-0882
Fax Number	:	844-440-2147

Provider Business Practice Location Address
First Line	:	809 W MAIN ST STE C
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2172
Country	:	US
Telephone Number	:	206-552-0882
Fax Number	:	844-440-2147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	01/08/2026

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