Provider Demographics
NPI:1811127541
Name:CULVER, MYRANDA J (MFT)
Entity type:Individual
Prefix:MS
First Name:MYRANDA
Middle Name:J
Last Name:CULVER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 14 WEST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1312
Mailing Address - Country:US
Mailing Address - Phone:608-647-6384
Mailing Address - Fax:608-647-8867
Practice Address - Street 1:1000 HIGHWAY 14 WEST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1312
Practice Address - Country:US
Practice Address - Phone:608-647-6384
Practice Address - Fax:608-647-8867
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist