Provider Demographics
NPI:1336030956
Name:CULP, JUSTINE ELAINE (STUDENT-INTERN)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ELAINE
Last Name:CULP
Suffix:
Gender:F
Credentials:STUDENT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 GRELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5460
Mailing Address - Country:US
Mailing Address - Phone:530-905-3545
Mailing Address - Fax:
Practice Address - Street 1:1900 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2629
Practice Address - Country:US
Practice Address - Phone:618-267-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor