Provider Demographics
NPI:1497738959
Name:CULVER, MARY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:CULVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10551 BARKLEY ST
Mailing Address - Street 2:SUITE #512
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1812
Mailing Address - Country:US
Mailing Address - Phone:913-626-1030
Mailing Address - Fax:913-317-8193
Practice Address - Street 1:10551 BARKLEY ST
Practice Address - Street 2:SUITE #512
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1812
Practice Address - Country:US
Practice Address - Phone:913-626-1030
Practice Address - Fax:913-317-8193
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21037101YM0800X
KSLP0915103T00000X
MOPY01784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
3079447OtherCIGNA
092443OtherMANAGED HEALTH NETWORK
6160116OtherUNITED HEALTH CARE
24238031OtherBLUE CROSS
29069OtherNEW DIRECTIONS
24238031OtherBLUE CROSS
6160116OtherUNITED HEALTH CARE
092443OtherMANAGED HEALTH NETWORK