Provider Demographics
NPI:1003800210
Name:MCCULLEY, SUSAN E (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MANTOOTH AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3014
Mailing Address - Country:US
Mailing Address - Phone:936-639-4993
Mailing Address - Fax:936-639-6838
Practice Address - Street 1:459 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3510
Practice Address - Country:US
Practice Address - Phone:409-384-2340
Practice Address - Fax:409-384-8060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional