Provider Demographics
NPI:1699452532
Name:MCCULLOUGH, KIMBERLY VOSS (MHCA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VOSS
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2609
Mailing Address - Country:US
Mailing Address - Phone:206-898-2085
Mailing Address - Fax:
Practice Address - Street 1:4105 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2609
Practice Address - Country:US
Practice Address - Phone:206-898-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61455951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor