Provider Demographics
NPI:1336292226
Name:MCCULLA, MEAGHAN S
Entity Type:Individual
Prefix:MS
First Name:MEAGHAN
Middle Name:S
Last Name:MCCULLA
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 1:18 WILBER ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3883
Mailing Address - Country:US
Mailing Address - Phone:603-903-2817
Mailing Address - Fax:
Practice Address - Street 1:18 WILBER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3883
Practice Address - Country:US
Practice Address - Phone:603-903-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid