Provider Demographics
NPI:1346413531
Name:MCCULLOUGH, EMILY EVE (LMFT, CADC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:EVE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2207
Mailing Address - Country:US
Mailing Address - Phone:515-576-4156
Mailing Address - Fax:515-576-6998
Practice Address - Street 1:1200 3RD AVE NW
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2207
Practice Address - Country:US
Practice Address - Phone:515-576-4156
Practice Address - Fax:515-576-6998
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist