Provider Demographics
NPI:1164729679
Name:CULBERSON, CHERYL CROSLEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:CROSLEY
Last Name:CULBERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2707
Mailing Address - Country:US
Mailing Address - Phone:940-808-9933
Mailing Address - Fax:940-484-7835
Practice Address - Street 1:3105 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2707
Practice Address - Country:US
Practice Address - Phone:940-808-9933
Practice Address - Fax:940-484-7835
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67405101YP2500X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTEXASMedicaid