Provider Demographics
NPI:1558757310
Name:MCCULLOCH, BRIANNA MARIE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:MARIE
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MARSHALL RD APT 218
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5980
Mailing Address - Country:US
Mailing Address - Phone:707-718-1103
Mailing Address - Fax:
Practice Address - Street 1:1701 MARSHALL RD APT 218
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5980
Practice Address - Country:US
Practice Address - Phone:707-718-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist