Healthcare Provider Details

I. General information

NPI: 1023017738
Provider Name (Legal Business Name): CORIE LYNN KULP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W LINCOLN AVE CORIE KULP COUNSELING PC
GOSHEN IN
46526-5907
US

IV. Provider business mailing address

1930 W LINCOLN AVE CORIE KULP COUNSELING PC
GOSHEN IN
46526-5907
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2161
  • Fax: 574-534-3887
Mailing address:
  • Phone: 574-534-2161
  • Fax: 574-522-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004681A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: