Individual
MARK ALLEN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LADC-MH CAND
Contact information
Practice address
13707 FAIRHILL AVE, EDMOND, OK 73013-1946
(405) 607-4041
Mailing address
13707 FAIRHILL AVE, EDMOND, OK 73013-1946
(405) 607-4041
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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