Provider Demographics
NPI:1982421426
Name:MCCULLY, ELIZABETH M (LSWAIC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MCCULLY
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 196TH ST SW C/O RXDX MEDICAL BILLING SVC LLC,
Mailing Address - Street 2:STE 310
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-256-7987
Mailing Address - Fax:
Practice Address - Street 1:5108 196TH ST SW STE 350
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6169
Practice Address - Country:US
Practice Address - Phone:425-582-2041
Practice Address - Fax:425-527-0468
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61281939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health