Provider Demographics
NPI:1508632597
Name:MCCULLEY, ALLEN (RBT)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MCCULLEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 N BEACH ST STE 146
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4253
Mailing Address - Country:US
Mailing Address - Phone:682-238-1872
Mailing Address - Fax:
Practice Address - Street 1:12650 N BEACH ST STE 146
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4253
Practice Address - Country:US
Practice Address - Phone:682-238-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-304947106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician