Provider Demographics
NPI:1376037952
Name:CULLUM, APRIL
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:CULLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AURELIA
Other - Middle Name:
Other - Last Name:CULLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AURELIA CULLUM
Mailing Address - Street 1:5305 BUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9252
Mailing Address - Country:US
Mailing Address - Phone:765-760-2908
Mailing Address - Fax:
Practice Address - Street 1:5305 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9252
Practice Address - Country:US
Practice Address - Phone:765-760-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-51631106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty