Provider Demographics
NPI:1134012891
Name:MCCULLOUGH, JENNIFER (ACMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CRAWFORDS COVE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-4626
Mailing Address - Country:US
Mailing Address - Phone:205-530-0435
Mailing Address - Fax:
Practice Address - Street 1:736 S 900 E STE 203-D
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7000
Practice Address - Country:US
Practice Address - Phone:385-777-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142242206009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health