Provider Demographics
NPI:1447931670
Name:CULKIN, COURTNEY (LMHC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CULKIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TERRY ST APT 310
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3875
Mailing Address - Country:US
Mailing Address - Phone:646-591-8545
Mailing Address - Fax:
Practice Address - Street 1:20 TERRY ST APT 310
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3875
Practice Address - Country:US
Practice Address - Phone:646-591-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013303-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty