Provider Demographics
NPI:1205906237
Name:CULBERTSON, SUSAN SPILLER (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SPILLER
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E SOUTH TEMPLE
Mailing Address - Street 2:#550
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1206
Mailing Address - Country:US
Mailing Address - Phone:801-597-2371
Mailing Address - Fax:801-355-9322
Practice Address - Street 1:515 S 700 E STE 3A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2873
Practice Address - Country:US
Practice Address - Phone:801-567-3544
Practice Address - Fax:801-355-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135887-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health