Healthcare Provider Details

I. General information

NPI: 1427802495
Provider Name (Legal Business Name): CULLEN HUSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E ST STE 2E
DAVIS CA
95616-4572
US

IV. Provider business mailing address

105 E ST STE 2E
DAVIS CA
95616-4572
US

V. Phone/Fax

Practice location:
  • Phone: 530-341-8180
  • Fax:
Mailing address:
  • Phone: 530-341-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: