Provider Demographics
NPI:1134953250
Name:MCCULLOCH, ASHLEY (CSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1342 W NECTARINE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5834
Mailing Address - Country:US
Mailing Address - Phone:801-615-6354
Mailing Address - Fax:
Practice Address - Street 1:11650 S STATE ST STE 104
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7144
Practice Address - Country:US
Practice Address - Phone:801-867-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10113758-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical