Ludella McCullough-Lee

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

300564 Issued in AZ

Practice address

358 E Javelina Ave
Mesa, AZ 85210-6205

Phone

(480) 507-3180

NPI assigned

Jun 8, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alliance Healthcare ServicesGroup PAC ID 4082766621, 28 clinicians

Community Bridges IncGroup PAC ID 2062699721, 106 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ludella.mcculloughlenp.p1@direct.cbridges.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Bridges, Inc.

  • Adult Mental Health Clinic/Center
  • Page, AZ
  • NPI 1558095315
  Medicare reassignment Care Compare group NPD
• Alliance Healthcare Services

  • Community/Behavioral Health Agency
  • Memphis, TN
  • NPI 1295898393
  Medicare reassignment Care Compare group NPD
• Community Bridges, Inc.

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1588348775
  NPD
• Community Bridges, Inc.

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1891068813
  NPD
• Alliance Healthcare Services

  • Clinic Pharmacy
  • Memphis, TN
  • NPI 1912312828
  NPD
• Community Bridges, Inc.

  • Substance Abuse Rehabilitation Facility
  • Mesa, AZ
  • NPI 1356461727
  NPD (past)
• Community Bridges, Inc.

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1649426909
  NPD (past)
• Community Bridges, Inc.

  • Nursing Care Agency
  • Phoenix, AZ
  • NPI 1891288049
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1093409369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8135 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386542103",
            "telephone_number": "662-318-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 E JAVELINA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106205",
            "telephone_number": "480-507-3180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8135 Goodman Rd",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386542103",
            "country_code": "US",
            "telephone_number": "662-318-5018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH-LEE",
        "first_name": "LUDELLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-08",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "906019",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "300564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cari McCormick, LAC
• Derrrick McCoy, BHT
• Jaime Larae McCoy, FNP-C
• Katherine Ena McCuaig, MD
• Stefanie Lyn McCullen, RN
• Erica Marie McCullough, LMFT
• Amanda McDaniel
• Holly McDaniel, M.D.
• Katrina McDaniel, PA-C
• Kelly McKenna McDermott, MS, CCC-SLP

• Psychiatric/Mental Health Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.