Provider Demographics
NPI:1437928983
Name:CULBRETH, JASON (LPC-A)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CULBRETH
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MIDDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4339
Mailing Address - Country:US
Mailing Address - Phone:203-788-1098
Mailing Address - Fax:
Practice Address - Street 1:150 MIDDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4339
Practice Address - Country:US
Practice Address - Phone:203-788-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health