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Individual

KELLY MCCULLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
715 W COURT ST, PASCO, WA 99301-4153
(509) 554-6506
(509) 546-0520
Mailing address
1707 W 34TH AVE, KENNEWICK, WA 99337-3838

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60184864
WA

Other

Enumeration date
08/07/2015
Last updated
10/12/2018
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