Mark Allen McCullough, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW696 Issued in ID

Practice address

5400 W Franklin Road
Suite H
Boise, ID 83705

Phone

(208) 345-1170

Fax

(208) 345-3502

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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 Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Boise, ID
  • NPI 1003752353
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Middleton, ID
  • NPI 1124952544
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Middleton, ID
  • NPI 1285568600
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Boise, ID
  • NPI 1396249546

  Clinical

  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Middleton, ID
  • NPI 1528992955
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Parma, ID
  • NPI 1528996022
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Nampa, ID
  • NPI 1669976957
  NPD (past)
• Community Health Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Boise, ID
  • NPI 1952252090
  NPD (past)
• Community Health Clinics, Inc.

  • Community/Retail Pharmacy
  • Meridian, ID
  • NPI 1043794001
  NPD (past)
• Community Health Clinics, Inc.

  • Dental Clinic/Center
  • Meridian, ID
  • NPI 1073001699
  NPD (past)
• Community Health Clinics, Inc.

  • Dental Clinic/Center
  • Boise, ID
  • NPI 1073092771
  NPD (past)
• Community Health Clinics, Inc.

  • Community/Retail Pharmacy
  • Marsing, ID
  • NPI 1114123304
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1932160488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "address_2": "211 16TH AVENUE NORTH",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-467-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 W FRANKLIN ROAD",
            "address_2": "SUITE H",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83705",
            "telephone_number": "208-345-1170",
            "fax_number": "208-345-3502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "1690636",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregg H. McCulloch, PHARM.D.
• Mary Polleys McCulloch, NNP
• Alissa T McCullough, RDN
• Jocelyn L McCullough, CNS
• Judit Ibolya McCullough, D.C.
• Michael Warren McCullough, DC
• Nancy McCullough, OTR
• Sandra Cheryl McCullough, LCPC
• Brett A McCurdy, RD
• Allie D McCurry, MD

• All providers in Boise, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.