Individual ProviderPhoenix MccullochSocial WorkerBehavioral Health & Social Service ProvidersPractice Address3050 SE Division St Ste 205, Portland, OR 97202-1997(971) 808-2115(503) 233-4356PECOS EnrollmentBased on the most recent information from CMS, provider Phoenix Mcculloch does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1083897912Provider TypeIndividualFull NameMcculloch, PhoenixCredentialMSWGenderFemaleSole ProprietorYesEnumeration Date12/13/2007Last Updated5/22/2023Contact InformationPractice LocationPractice Address3050 SE Division St Ste 205, Portland, OR 97202-1997Phone(971) 808-2115FaxUnlisted FaxMailing LocationMailing Address1500 NE Irving St, Suite 250, Portland, OR 97232-2243Phone(503) 233-4356FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer