Provider Demographics
NPI:1265165153
Name:MCCULLOUGH, JULIAN RAFFERTY (PHD, LPC, LMHC)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:RAFFERTY
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:PHD, LPC, LMHC
Other - Prefix:DR
Other - First Name:RAFE
Other - Middle Name:
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, LMHC
Mailing Address - Street 1:1307 NE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3619
Mailing Address - Country:US
Mailing Address - Phone:206-898-9421
Mailing Address - Fax:
Practice Address - Street 1:1307 NE 43RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3619
Practice Address - Country:US
Practice Address - Phone:206-898-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5864101YM0800X
GALPC009458101YM0800X
WAMX61291003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health