MEDICARE: CYNTHIA MARIE CULBREATH M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHI7163	FL

General Provider Information

NPI Number	:	1457616856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA MARIE CULBREATH M.A.

Provider Business Mailing Address
First Line	:	3201 34TH ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-3828
Country	:	US
Telephone Number	:	727-455-7451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 34TH ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-3828
Country	:	US
Telephone Number	:	727-455-7451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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