Provider Demographics
NPI:1467882167
Name:CULVER, GREGORY R (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:R
Last Name:CULVER
Suffix:
Gender:M
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 1:16780 BRYANT RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5572
Mailing Address - Country:US
Mailing Address - Phone:971-277-8378
Mailing Address - Fax:
Practice Address - Street 1:16780 BRYANT RD STE 5
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5572
Practice Address - Country:US
Practice Address - Phone:971-277-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health