Debra Karen Kullberg, L.A.M.F.T., M.DIV.

Individual provider Active NPI Marriage & Family Therapist · Mound, MN

NPI 1386800977 · NPPES record last updated Aug 27, 2009

Key facts

NPI
1386800977
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
1886 (MN)
Practice address
1567 Bluebird LN
Mound, MN 55364-1109
Phone
(952) 472-5848
NPI assigned
Aug 2, 2008
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1886MNMDMarriage & Family Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1886 MN Yes

Addresses

Primary practice location

1567 Bluebird LN
Mound, MN 55364-1109

Mailing address

1567 Bluebird LN
Mound, MN 55364-1109
Phone (952) 472-5848

Other providers in Mound, MN

All providers in Mound, MN · Marriage & Family Therapist in Minnesota

Sources for this page

Verify at the official NPI Registry.