Provider Demographics
NPI:1760207161
Name:CULLEN-DUNMEYER, KRISTIN MARIE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:CULLEN-DUNMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ROSEHEDGE LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1015
Mailing Address - Country:US
Mailing Address - Phone:818-203-2737
Mailing Address - Fax:
Practice Address - Street 1:107 ROSEHEDGE LN
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-1015
Practice Address - Country:US
Practice Address - Phone:818-203-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC10639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional