Provider Demographics
NPI:1063477958
Name:CULLY, MARLANE KOHL
Entity Type:Individual
Prefix:DR
First Name:MARLANE
Middle Name:KOHL
Last Name:CULLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 W. INGOMAR ROAD
Mailing Address - Street 2:P.O. BOX 128
Mailing Address - City:INGOMAR
Mailing Address - State:PA
Mailing Address - Zip Code:15127
Mailing Address - Country:US
Mailing Address - Phone:412-346-4697
Mailing Address - Fax:
Practice Address - Street 1:557 OLIVE ST.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-346-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC 001254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC 001254OtherLICENSE NO.
PAPC 001254OtherLICENSE NO.