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General NPI Number Information
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NPI Number | 1255024303
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Entity Type | Individual
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Provider Name | JASON MATTHEW CULP LPC
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Gender | Male
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 28922 LORAIN RD STE 102
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-4054
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Country | US
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Telephone | 440-360-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 6422 SILVERSTONE LN
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City | MEDINA
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State | OH
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Zip | 44256-5537
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Country | US
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Telephone | 440-653-7470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.1100309
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.1100309
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License Number State | OH
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