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General NPI Number Information
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NPI Number | 1568964575
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Entity Type | Organization
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Legal Business Name | DOUGLAS CULBERT, PHD
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE STE 2401
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City | CHICAGO
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State | IL
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Zip | 60601-7451
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Country | US
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Telephone | 312-467-1519
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 W GLENLAKE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-2504
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Country | US
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Telephone | 773-844-6576
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. DOUGLAS S CULBERT
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Credential | PHD
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Telephone | 312-467-1519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004224
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License Number State | IL
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