Provider Demographics
NPI:1790166882
Name:MCCULLOUGH, CHERLETTE (LMFT)
Entity type:Individual
Prefix:
First Name:CHERLETTE
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LEE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1847
Mailing Address - Country:US
Mailing Address - Phone:321-217-6392
Mailing Address - Fax:
Practice Address - Street 1:1950 LEE RD STE 110
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1847
Practice Address - Country:US
Practice Address - Phone:321-217-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205749106H00000X
FLMT4708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist