Jonathan Peter McCulloch, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851115199 Issued in MI

Practice address

Colonial Woods Christian Counseling Center
1101 Military Street
Port Huron, MI 48060-5418

Phone

(810) 984-5575

Fax

(810) 984-6433

NPI assigned

Oct 27, 2011

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Colonial Woods Missionary Church

  • Clinic/Center
  • Port Huron, MI
  • NPI 1033372818
  NPD

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1730465311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COLONIAL WOODS CHRISTIAN COUNSELING CENTER",
            "address_2": "1101 MILITARY STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605418",
            "telephone_number": "810-984-5575",
            "fax_number": "810-984-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COLONIAL WOODS CHRISTIAN COUNSELING CENTER",
            "address_2": "1101 MILITARY STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605418",
            "telephone_number": "810-984-5575",
            "fax_number": "810-984-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOCH",
        "first_name": "JONATHAN",
        "middle_name": "PETER",
        "name_prefix": "Mr.",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-27",
        "last_updated": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851115199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jo Anne McCartney
• Tracie McClarty, LPN
• Rebekah Jeanne McClearen
• Alexandria Mae McCracken, LLMSW
• John C McCue, CRNA
• Eddia Marie McDade, PHD, PMHNP, RN
• Erin Michelle McDaid, LMSW
• Bradley J McDonald, LMSW
• Homeira McDonald, MD
• Kaitlyn McDonald, LLMSW

• Clinical Social Worker in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.