Provider Demographics
NPI:1013387042
Name:CULBERTSON, EMILY (CADC II, QMHA II)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:CADC II, QMHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NW 5TH ST
Mailing Address - Street 2:BOX 1710
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1869
Mailing Address - Country:US
Mailing Address - Phone:541-516-4099
Mailing Address - Fax:541-504-1195
Practice Address - Street 1:340 NW 5TH ST
Practice Address - Street 2:BOX 1710
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:540-516-4087
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-II-000113101YM0800X
OR14-CRM-076104100000X
OR23-08-20311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker