Organization
LEGENDS EQUESTRIAN THERAPY
Active
Organization
LEGENDS EQUESTRIAN THERAPY
Active
Other names
Legends Equestrian Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE M. MCCULLOUGH PHD, LSCSW, LCSW (PSYCHOTHERAPIST)
(210) 885-8696
Entity
Organization
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
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201201540A
—
KS
Enumeration date
03/03/2020
Last updated
03/03/2020
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