Provider Demographics
NPI:1902693500
Name:MCCOLLOUGH, RICHARD J (CPSS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MCCOLLOUGH
Suffix:
Gender:
Credentials:CPSS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:MCCOLLOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPSS
Mailing Address - Street 1:1681 THE ALAMEDA APT 32
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2211
Mailing Address - Country:US
Mailing Address - Phone:408-412-2666
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-PJMOKV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist