Individual
MALISSA M MCCULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
220 10TH AVE S, NAMPA, ID 83651-3832
(208) 468-0850
Mailing address
220 10TH AVE S, NAMPA, ID 83651-3832
(208) 468-0850
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9731
ID
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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