Individual
CHASE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NLC
Contact information
Practice address
1215 2ND ST, VONA, CO 80861-5002
(719) 349-0413
Mailing address
PO BOX 45, VONA, CO 80861-0045
(719) 349-0413
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
NLC.0109962
CO
104100000X
Social Worker
—
—
Other
Enumeration date
05/01/2017
Last updated
09/07/2021
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