Provider Demographics
NPI:1689216376
Name:NALL-MCCULLEY, COURTNEY TAYLOR (MA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:NALL-MCCULLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:TAYLOR
Other - Last Name:NALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3929 AIRPORT BLVD STE 2-413
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2239
Mailing Address - Country:US
Mailing Address - Phone:251-343-0566
Mailing Address - Fax:
Practice Address - Street 1:3929 AIRPORT BLVD STE 2-413
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2239
Practice Address - Country:US
Practice Address - Phone:251-343-0566
Practice Address - Fax:251-343-0120
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3370A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health