Provider Demographics
NPI:1124649199
Name:MCCULLOUGH, ATHENA M (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:M
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W CROSS DR STE 509
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0761
Mailing Address - Country:US
Mailing Address - Phone:720-257-9121
Mailing Address - Fax:
Practice Address - Street 1:9200 W CROSS DR STE 509
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-0761
Practice Address - Country:US
Practice Address - Phone:720-257-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002314106H00000X
COLPC.0018682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty