Basic Information
| Provider Information | |||||||||
| NPI: | 1265535496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCULLEY | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 896 BLYTHE ST | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381045708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018480010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 210 MANOR ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723641936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707396818 | ||||||||
| FaxNumber: | 8707391970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1751-C | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.