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Individual
DR. MARY IRENE MCCULLOUGH
Active
Individual
DR. MARY IRENE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSSP, LPC-S, NCC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
64887
TX
101YM0800X
Mental Health Counselor
64887
TX
101YP2500X
Professional Counselor
Primary
64887
TX
101YS0200X
School Counselor
64887
TX
251B00000X
Case Management Agency
64887
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300235402
—
TX
Enumeration date
07/02/2012
Last updated
07/22/2016
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