Provider Demographics
NPI:1962620559
Name:KULLMAN, ALITTA LEA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALITTA
Middle Name:LEA
Last Name:KULLMAN
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 1:25682 NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7504
Mailing Address - Country:US
Mailing Address - Phone:949-582-5602
Mailing Address - Fax:949-582-7603
Practice Address - Street 1:260 NEWPORT CENTER DR STE 513
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7520
Practice Address - Country:US
Practice Address - Phone:949-933-5602
Practice Address - Fax:949-582-7603
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT5793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist