Individual
MS. LESLIE MARIE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW, LCSW
Contact information
Practice address
1212 SW MULVANE ST, TOPEKA, KS 66604-1442
(210) 885-8696
Mailing address
PO BOX 4171, TOPEKA, KS 66604-0171
(210) 885-8696
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
02227
TX
104100000X
Social Worker
Primary
10642
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00506W
BC BS
TX
05
—
110004202
—
TX
05
—
2012015401
—
KS
Enumeration date
02/06/2007
Last updated
03/03/2020
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