Provider Demographics
NPI:1194396101
Name:MCCULLEY, LEAH K (LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHERINE
Other - Last Name:GORHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:710 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4387
Mailing Address - Country:US
Mailing Address - Phone:405-921-3815
Mailing Address - Fax:
Practice Address - Street 1:710 N 64TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4387
Practice Address - Country:US
Practice Address - Phone:254-772-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty