Provider Demographics
NPI:1124566237
Name:CULBERTSON, PATRICIA ANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3338
Mailing Address - Country:US
Mailing Address - Phone:636-535-7472
Mailing Address - Fax:888-474-0821
Practice Address - Street 1:12601 MO-21
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-3315
Practice Address - Country:US
Practice Address - Phone:636-535-7472
Practice Address - Fax:888-474-0821
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019043830101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional