MEDICARE: BEVERLY MCCULLOUGH

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1609616226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY MCCULLOUGH

Provider Business Mailing Address
First Line	:	411 PECAN TREE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-1823
Country	:	US
Telephone Number	:	334-647-5710
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 PECAN TREE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-1823
Country	:	US
Telephone Number	:	857-829-4040
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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Directions to “ BEVERLY MCCULLOUGH ” Practice Location

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