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General NPI Number Information
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NPI Number | 1962943050
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Entity Type | Individual
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Provider Name | COLLEEN CULTON LCDC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 601 OLD OAKS RANCH RD
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City | WIMBERLEY
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State | TX
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Zip | 78676-5972
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Country | US
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Telephone | 512-573-1817
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Fax |
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Provider Business Mailing Address
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Address Line | 11711 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-2101
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8874
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License Number State | TX
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