MEDICARE: MADELINE ELAINE MCCULLOCH

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	103K00000X	Behavior Analyst	9455	TX

General Provider Information

NPI Number	:	1760346456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE ELAINE MCCULLOCH

Provider Business Mailing Address
First Line	:	3305 LONG PRAIRIE RD STE 105
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2775
Country	:	US
Telephone Number	:	469-699-4931
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 LONG PRAIRIE RD STE 105
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2775
Country	:	US
Telephone Number	:	469-699-4931
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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