Provider Demographics
NPI:1780988667
Name:MCCULLOUGH, SIOBHAN MEGAN (MS,LCPC,NCC,BC-TMH)
Entity type:Individual
Prefix:MRS
First Name:SIOBHAN
Middle Name:MEGAN
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MS,LCPC,NCC,BC-TMH
Other - Prefix:
Other - First Name:SIOBHAN
Other - Middle Name:MEGAN MCCULLOUGH
Other - Last Name:PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 SAINT CRONAN CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3415
Mailing Address - Country:US
Mailing Address - Phone:815-242-5450
Mailing Address - Fax:815-246-0750
Practice Address - Street 1:18 SAINT CRONAN CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3415
Practice Address - Country:US
Practice Address - Phone:815-242-5450
Practice Address - Fax:815-331-2996
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI995-226101Y00000X
IL180.009536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor