Provider Demographics
NPI:1770052755
Name:CULP, JUDY M
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:CULP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 THE WILLOWS
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5846
Mailing Address - Country:US
Mailing Address - Phone:574-875-9998
Mailing Address - Fax:
Practice Address - Street 1:224 THE WILLOWS
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5846
Practice Address - Country:US
Practice Address - Phone:574-875-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33001693A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health