Provider Demographics
NPI:1336632363
Name:MCCULLEN, JOYCE (LCDC)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:MCCULLEN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 NORTH LAMAR BOULEVARD
Mailing Address - Street 2:D-109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-454-8180
Mailing Address - Fax:512-454-7441
Practice Address - Street 1:7801 N LAMAR BLVD STE D109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1036
Practice Address - Country:US
Practice Address - Phone:512-454-8180
Practice Address - Fax:512-454-7441
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty