Provider Demographics
NPI:1942354329
Name:SUSAN B KULLMAN LTD
Entity Type:Organization
Organization Name:SUSAN B KULLMAN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:928-445-0231
Mailing Address - Street 1:536 S CORTEZ ST
Mailing Address - Street 2:STE 1C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4354
Mailing Address - Country:US
Mailing Address - Phone:928-445-0231
Mailing Address - Fax:
Practice Address - Street 1:915 E GURLEY ST
Practice Address - Street 2:STE 105
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3244
Practice Address - Country:US
Practice Address - Phone:928-445-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105658Medicare ID - Type Unspecified