Provider Demographics
NPI:1457104697
Name:CULLEN, CAROLYN (PPS COUNSELING)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:PPS COUNSELING
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:HURLBUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 W LUGONIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2234
Mailing Address - Country:US
Mailing Address - Phone:909-524-2313
Mailing Address - Fax:
Practice Address - Street 1:301 W SOUTH AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7039
Practice Address - Country:US
Practice Address - Phone:909-524-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200118460101YS0200X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor