Provider Demographics
NPI:1528263399
Name:MCCULLAR, TERA L (BA)
Entity type:Individual
Prefix:MISS
First Name:TERA
Middle Name:L
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:ROFF
Mailing Address - State:OK
Mailing Address - Zip Code:74865-0524
Mailing Address - Country:US
Mailing Address - Phone:580-399-3699
Mailing Address - Fax:580-421-3150
Practice Address - Street 1:1308 CRADDUCK RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-8442
Practice Address - Country:US
Practice Address - Phone:580-332-3699
Practice Address - Fax:580-421-9828
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator