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General NPI Number Information
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NPI Number | 1770791394
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Entity Type | Individual
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Provider Name | DOUGLAS S CULBERT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 405 N WABASH AVE SUITE 4507
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City | CHICAGO
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State | IL
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Zip | 60611-3591
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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 | 5737 S UNIVERSITY AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1507
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Country | US
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Telephone | 312-467-1519
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 71004224
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License Number State | IL
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