Provider Demographics
NPI:1023338837
Name:CULLEN, LEILANI RAY (MA LMFT)
Entity type:Individual
Prefix:MRS
First Name:LEILANI
Middle Name:RAY
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MRS
Other - First Name:LEILANI
Other - Middle Name:RAY
Other - Last Name:KEATOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:1949 SUGARLAND DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5764
Mailing Address - Country:US
Mailing Address - Phone:719-964-0833
Mailing Address - Fax:307-624-6254
Practice Address - Street 1:1949 SUGARLAND DR STE 250
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5764
Practice Address - Country:US
Practice Address - Phone:307-242-1472
Practice Address - Fax:307-624-6254
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO913106H00000X
HI240106H00000X
WY254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14924323Medicaid