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Individual
MARY ELLEN MCCULLOUGH-LIST
Active
Individual
MARY ELLEN MCCULLOUGH-LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18--72833
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-72833
REGISTERED BEHAVIOR TECHNICIAN CERTIFICATION
—
Enumeration date
02/18/2019
Last updated
01/07/2022
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