Provider Demographics
NPI:1356570337
Name:MCCULLY, PATRICK WAYNE
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WAYNE
Last Name:MCCULLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NORTHPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5004
Mailing Address - Country:US
Mailing Address - Phone:707-571-5581
Mailing Address - Fax:707-571-5531
Practice Address - Street 1:2300 NORTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407
Practice Address - Country:US
Practice Address - Phone:707-571-5581
Practice Address - Fax:707-571-5531
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health