1679868632 NPI number — MS. ELAINE KATHRYN CULVERWELL LMFT

Table of content: MS. ELAINE KATHRYN CULVERWELL LMFT (NPI 1679868632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679868632 NPI number — MS. ELAINE KATHRYN CULVERWELL LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULVERWELL
Provider First Name:
ELAINE
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679868632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46090 SENTINEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94539-6952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-651-1228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOWRY AVE
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-552-0702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC41741 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com