Provider Demographics
NPI:1750343836
Name:CULLUM, COLIN MUNRO (PHD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:MUNRO
Last Name:CULLUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:C
Other - Middle Name:MUNRO
Other - Last Name:CULLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:PSYCHOLOGY DIVISION, UT SOUTHWESTERN MED CTR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9044
Mailing Address - Country:US
Mailing Address - Phone:214-648-5270
Mailing Address - Fax:214-648-4660
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:PSYCHOLOGY DIVISION, UT SOUTHWESTERN MED CTR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9044
Practice Address - Country:US
Practice Address - Phone:214-648-5270
Practice Address - Fax:214-648-4660
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25327103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81634PMedicare ID - Type Unspecified
S07376Medicare UPIN