Provider Demographics
NPI:1730245465
Name:CULLUM, MARILYN J (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:CULLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
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Mailing Address - Street 1:139 COUNTY ROAD 395
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396
Mailing Address - Country:US
Mailing Address - Phone:870-238-5596
Mailing Address - Fax:870-208-9229
Practice Address - Street 1:1742 FALLS BLVD. SUITE 5
Practice Address - Street 2:THE LOGAN CENTER
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-208-9333
Practice Address - Fax:870-208-9229
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9807016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U425OtherBLUE CROSS BLUE SHIELD