Provider Demographics
NPI:1568964575
Name:DOUGLAS CULBERT, PHD
Entity Type:Organization
Organization Name:DOUGLAS CULBERT, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:CULBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-467-1519
Mailing Address - Street 1:1220 W GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2504
Mailing Address - Country:US
Mailing Address - Phone:773-844-6576
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 2401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7451
Practice Address - Country:US
Practice Address - Phone:312-467-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty