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NPI Code Detail

MEDICARE: KENNETH DAVID CULBERTSON BCBA

MEDICARE: KENNETH DAVID CULBERTSON BCBA
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
1103TB0200XCognitive & Behavioral PsychologistFL
2106S00000XBehavior TechnicianRBT-18-73414FL
3103K00000XBehavior Analyst1-25-79013TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841763422
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DAVID CULBERTSON BCBA
Provider Business Mailing Address
First Line : 108 LOWER MILL CREEK RD
Second Line :
City : ROCKY FACE
State : GA
Zip : 30740-3202
Country : US
Telephone Number : 618-309-2681
Fax Number :
Provider Business Practice Location Address
First Line : 177 MOUSE CREEK RD NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3838
Country : US
Telephone Number : 423-212-3663
Fax Number : 706-780-1705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2019
Last Update Date : 03/26/2025

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