Provider Demographics
NPI:1184851271
Name:MCCULLOUGH, LINDA (MA,LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 HAMPTON COURT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2322
Mailing Address - Country:US
Mailing Address - Phone:503-341-6641
Mailing Address - Fax:503-766-4778
Practice Address - Street 1:6420 SW MACADAM AVE STE 390
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3564
Practice Address - Country:US
Practice Address - Phone:503-341-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional