Provider Demographics
NPI:1609928597
Name:MCCULLOUGH, CLAIRE BOYETTE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:BOYETTE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5404
Mailing Address - Country:US
Mailing Address - Phone:216-765-0500
Mailing Address - Fax:
Practice Address - Street 1:23240 CHAGRIN BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5404
Practice Address - Country:US
Practice Address - Phone:216-765-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500422101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor