Basic Information
| Provider Information | |||||||||
| NPI: | 1750343836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULLUM | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | MUNRO | ||||||||
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| Credential: | PHD | ||||||||
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| OtherLastName: | CULLUM | ||||||||
| OtherFirstName: | C | ||||||||
| OtherMiddleName: | MUNRO | ||||||||
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| OtherCredential: | PHD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | PSYCHOLOGY DIVISION, UT SOUTHWESTERN MED CTR | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146485270 | ||||||||
| FaxNumber: | 2146484660 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | PSYCHOLOGY DIVISION, UT SOUTHWESTERN MED CTR | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146485270 | ||||||||
| FaxNumber: | 2146484660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 25327 | TX | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.