MARK ALLEN MCCULLOUGH

BOISE, ID
NPI1932160488
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: ID  LCSW696)
Enumeration Date2006-03-31
Last Update Date2008-07-16
Business Address
-- MARK ALLEN MCCULLOUGH LCSW
5400 W FRANKLIN ROAD SUITE H
BOISE, ID 83705
Phone number: 208-345-1170
Mailing Address
-- MARK ALLEN MCCULLOUGH LCSW
PO BOX 9 211 16TH AVENUE NORTH
NAMPA, ID 83653-0009
Phone number: 208-467-4431
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