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NPI Code Detail

MEDICARE: MS. SUSAN ELIZABETH MCCULLOUGH LCSW

MEDICARE: MS. SUSAN ELIZABETH MCCULLOUGH LCSW
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
11041C0700XClinical Social Worker992642CO

General Provider Information

NPI Number : 1881836336
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN ELIZABETH MCCULLOUGH LCSW
Provider Business Mailing Address
First Line : 700 FRONT ST
Second Line : SUITE 204
City : LOUISVILLE
State : CO
Zip : 80027-1805
Country : US
Telephone Number : 303-665-2676
Fax Number :
Provider Business Practice Location Address
First Line : 777 29TH ST STE 500
Second Line :
City : BOULDER
State : CO
Zip : 80303-2357
Country : US
Telephone Number : 970-310-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2009
Last Update Date : 11/20/2024

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