Provider Demographics
NPI:1194967323
Name:CULP, LAUREN MARTIN
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARTIN
Last Name:CULP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:MARTIN-CULP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:PO BOX 3605
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90408-3605
Mailing Address - Country:US
Mailing Address - Phone:310-917-9969
Mailing Address - Fax:
Practice Address - Street 1:1448 15TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2756
Practice Address - Country:US
Practice Address - Phone:310-917-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist