Provider Demographics
NPI:1417581711
Name:ANDREA KULBERG PHD
Entity Type:Organization
Organization Name:ANDREA KULBERG PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-309-1160
Mailing Address - Street 1:225 E CARRILLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2121
Mailing Address - Country:US
Mailing Address - Phone:970-309-1160
Mailing Address - Fax:
Practice Address - Street 1:225 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2121
Practice Address - Country:US
Practice Address - Phone:970-309-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1205192317Medicaid
CA1639668510Medicaid
CO1912334426Medicaid
CA1760898258Medicaid
CA195294873Medicaid