Provider Demographics
NPI:1386800977
Name:KULLBERG, DEBRA KAREN (LAMFT, MDIV)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAREN
Last Name:KULLBERG
Suffix:
Gender:F
Credentials:LAMFT, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1109
Mailing Address - Country:US
Mailing Address - Phone:952-472-5848
Mailing Address - Fax:
Practice Address - Street 1:1567 BLUEBIRD LN
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1109
Practice Address - Country:US
Practice Address - Phone:952-472-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-02
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist