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NPI Code Detail

MEDICARE: PAUL EDWARD MCCULLOUGH MFT

MEDICARE: PAUL EDWARD MCCULLOUGH MFT
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
1101YM0800XMental Health Counselor33485CA

General Provider Information

NPI Number : 1972662179
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL EDWARD MCCULLOUGH MFT
Provider Business Mailing Address
First Line : 2441 JACKSON ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-1324
Country : US
Telephone Number : 415-346-6384
Fax Number : 415-346-1803
Provider Business Practice Location Address
First Line : 2441 JACKSON ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-1324
Country : US
Telephone Number : 415-346-6384
Fax Number : 415-346-1803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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Directions to “ PAUL EDWARD MCCULLOUGH MFT” Practice Location

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