Provider Demographics
NPI:1740536200
Name:CULVER, JOHN DAVID (MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:CULVER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 E 2ND AVE
Mailing Address - Street 2:#205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5109
Mailing Address - Country:US
Mailing Address - Phone:970-259-1312
Mailing Address - Fax:970-247-0587
Practice Address - Street 1:954 E 2ND AVE
Practice Address - Street 2:#205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5109
Practice Address - Country:US
Practice Address - Phone:970-259-1312
Practice Address - Fax:970-247-0587
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional