Basic Information
| Provider Information | |||||||||
| NPI: | 1811164551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULPEPPER | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 N SHADY LN | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720153212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018608393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1405 N PIERCE ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722075379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016032147 | ||||||||
| FaxNumber: | 5016030324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P1012088 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.