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Provider Information for 1184763955


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Ms. LESLIE MARIE MCCULLOUGH LSCSW, LCSW


Other Names:  
Former Name: 
Dr. LESLIE MARIE MCCULLOUGH

Sex: Female

NPI: 1184763955
Last Updated: 2020-03-03
Certification Date: 2020-03-03

Details

NameValue
NPI1184763955
Enumeration Date2007-02-06
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 4171
TOPEKA, KS 66604-0171
United States

Phone: 210-885-8696 | Fax:
 
Primary Practice Address 1212 SW MULVANE ST
TOPEKA, KS 66604-1442
United States

Phone: 210-885-8696 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)TX00506WBC BS
MEDICAIDTX110004202
MEDICAIDKS2012015401
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 103T00000X - Psychologist TX02227
Yes 104100000X - Social Worker KS10642