Provider Demographics
NPI:1962647735
Name:CULLER, MARILYN ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:CULLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 LIBERTY AVE
Mailing Address - Street 2:#5
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1333
Mailing Address - Country:US
Mailing Address - Phone:440-963-0402
Mailing Address - Fax:440-963-4018
Practice Address - Street 1:5475 LIBERTY AVE
Practice Address - Street 2:#5
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1333
Practice Address - Country:US
Practice Address - Phone:440-963-0402
Practice Address - Fax:440-963-4018
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0602199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional