Individual
MS. LISA MICHELLE MCCULLOCH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
14377 WOODLAKE DR, SUITE 308, CHESTERFIELD, MO 63017
(314) 576-6493
(314) 576-7319
Mailing address
1222 DUNLOE ROAD, BALLWIN, MO 63021
(636) 207-1391
(636) 207-1391
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2001004734
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
691209
HEALTHLINK
MO
Enumeration date
02/27/2006
Last updated
07/08/2007
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