Mccullough, Mark Allen
Mccullough, Mark Allen is an individual health care provider with primary practice located at 5400 W Franklin Road Suite H, Boise ID 83705. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Mccullough, Mark Allen can be contacted via phone (208) 345-1170.Contact Information
Primary practice address
5400 W Franklin Road Suite H
Boise ID 83705
Phone: (208) 345-1170
Fax: (208) 345-3502
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | LCSW696 | Idaho |
Profile Details
| NPI number | 1932160488 |
|---|---|
| LBN Legal business name | Mccullough, Mark Allen |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2006 |
| Last updated | Jul 16th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932160488 | NPPES |
| Idaho | Other | 1690636 | CIGNA MEDICARE |
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