Provider Demographics
NPI:1336325851
Name:MCCOLOUGH, KRISTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MCCOLOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3246
Mailing Address - Country:US
Mailing Address - Phone:901-324-3637
Mailing Address - Fax:901-324-9114
Practice Address - Street 1:2430 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3246
Practice Address - Country:US
Practice Address - Phone:901-324-3637
Practice Address - Fax:901-324-9114
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2207-C1041C0700X
TNLSW00000048681041C0700X
OHI.0840051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical