Provider Demographics
NPI:1356907406
Name:CULP, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:CULP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7017
Mailing Address - Country:US
Mailing Address - Phone:907-357-8780
Mailing Address - Fax:907-357-8781
Practice Address - Street 1:124 W SWANSON AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6822
Practice Address - Country:US
Practice Address - Phone:907-357-8780
Practice Address - Fax:907-357-8781
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)