Provider Demographics
NPI:1841230901
Name:CULBERT, DAVID L (MA, CADC, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:CULBERT
Suffix:
Gender:M
Credentials:MA, CADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E KEARNEY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4610
Mailing Address - Country:US
Mailing Address - Phone:417-848-4900
Mailing Address - Fax:
Practice Address - Street 1:2032 E KEARNEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4610
Practice Address - Country:US
Practice Address - Phone:417-848-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3000OtherCSAC
MO499406007Medicaid