Provider Demographics
NPI:1942735170
Name:CULTON, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W PRIEN LAKE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8349
Mailing Address - Country:US
Mailing Address - Phone:337-310-2822
Mailing Address - Fax:337-990-5630
Practice Address - Street 1:710 W PRIEN LAKE RD
Practice Address - Street 2:STE 103
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8349
Practice Address - Country:US
Practice Address - Phone:337-310-2822
Practice Address - Fax:337-990-5630
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6205101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor