Provider Demographics
NPI:1326061102
Name:CULLEY-MCCULLOUGH, PAM (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAM
Middle Name:
Last Name:CULLEY-MCCULLOUGH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 BORDEN RD
Mailing Address - Street 2:SUITE 105-C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2162
Mailing Address - Country:US
Mailing Address - Phone:760-796-4567
Mailing Address - Fax:760-751-8658
Practice Address - Street 1:1081 BORDEN RD
Practice Address - Street 2:SUITE 105-C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2162
Practice Address - Country:US
Practice Address - Phone:760-796-4567
Practice Address - Fax:760-751-8658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12599AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAOPL125990Medicare UPIN