Provider Demographics
NPI:1073785234
Name:FULTON, RICHARD D (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:FULTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 CANFIELD DR
Mailing Address - Street 2:APT 1009
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4961
Mailing Address - Country:US
Mailing Address - Phone:817-296-5930
Mailing Address - Fax:817-457-7908
Practice Address - Street 1:7525 JOHN T WHITE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3311
Practice Address - Country:US
Practice Address - Phone:817-429-4769
Practice Address - Fax:817-457-7906
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18221101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)