Provider Demographics
NPI:1134450935
Name:MCCULLOUGH COUNSELING & RECOVERY LLC
Entity type:Organization
Organization Name:MCCULLOUGH COUNSELING & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LMHP, LADC
Authorized Official - Phone:402-457-5761
Mailing Address - Street 1:5951 AMES AVE
Mailing Address - Street 2:# 28
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2705
Mailing Address - Country:US
Mailing Address - Phone:402-457-5761
Mailing Address - Fax:402-457-1997
Practice Address - Street 1:5951 AMES AVE
Practice Address - Street 2:# 28
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2705
Practice Address - Country:US
Practice Address - Phone:402-457-5761
Practice Address - Fax:402-457-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE603251S00000X
NE3302251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025813200Medicaid