Provider Demographics
NPI:1518521954
Name:MCCOLLOUGH, BARBARA JEAN
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:MCCOLLOUGH
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 1:1895 CENTRE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1933
Mailing Address - Country:US
Mailing Address - Phone:617-645-2813
Mailing Address - Fax:
Practice Address - Street 1:1895 CENTRE ST STE 201
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1933
Practice Address - Country:US
Practice Address - Phone:617-645-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health