Healthcare Provider Details

I. General information

NPI: 1255245452
Provider Name (Legal Business Name): THALIA ROSE CULPUS MS, BA, QMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SW 4TH ST STE 302
MADRAS OR
97741-9629
US

IV. Provider business mailing address

PO BOX 1710
REDMOND OR
97756-0516
US

V. Phone/Fax

Practice location:
  • Phone: 541-475-6575
  • Fax:
Mailing address:
  • Phone: 541-475-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: