Provider Demographics
NPI:1427472075
Name:CULBERT, KRISTEN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:CULBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 W. GRAND RIVER
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7335
Mailing Address - Country:US
Mailing Address - Phone:517-242-2404
Mailing Address - Fax:
Practice Address - Street 1:7960 W. GRAND RIVER
Practice Address - Street 2:SUITE 120
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7335
Practice Address - Country:US
Practice Address - Phone:517-242-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015397103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist