NICOLE REALLE MCCULLOUGH NPI 1457852725

NPI Information

NPI: 1457852725
Provider Name: NICOLE REALLE MCCULLOUGH
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1411 SW MORRISON ST STE 310
PORTLAND, OR
ZIP 97205
Phone: (503) 799-4114
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Nicole Realle Mccullough is a mental health counselor in Portland, OR. Nicole Realle Mccullough NPI is 1457852725. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1411 SW MORRISON ST STE 310
PORTLAND, OR
ZIP 97205-945
Phone: (503) 799-4114

The enumeration date for this NPI number is 2/22/2018 and was last updated on 8/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health			Yes
2	106S00000X	Behavior Technician				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1396085718	MEDICAID	UTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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