Provider Demographics
NPI:1366873507
Name:CULLEY, MICHELLE (PC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CULLEY
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4528
Mailing Address - Country:US
Mailing Address - Phone:330-835-7477
Mailing Address - Fax:
Practice Address - Street 1:1550 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4528
Practice Address - Country:US
Practice Address - Phone:330-835-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor