Provider Demographics
NPI:1326867631
Name:CULICH, JOHN (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CULICH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-4459
Mailing Address - Country:US
Mailing Address - Phone:913-291-1600
Mailing Address - Fax:913-521-2039
Practice Address - Street 1:3004 N 27TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-4459
Practice Address - Country:US
Practice Address - Phone:913-291-1600
Practice Address - Fax:913-521-2039
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01851-T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)