Provider Demographics
NPI:1851794622
Name:MCCULLAGH, PATRICK JAMES
Entity Type:Individual
Prefix:MISS
First Name:PATRICK
Middle Name:JAMES
Last Name:MCCULLAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0660
Mailing Address - Country:US
Mailing Address - Phone:702-354-5636
Mailing Address - Fax:
Practice Address - Street 1:149 TYLER CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-0660
Practice Address - Country:US
Practice Address - Phone:702-354-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor