Provider Demographics
NPI:1124359690
Name:MARGARET A. FULTON, INC.
Entity Type:Organization
Organization Name:MARGARET A. FULTON, INC.
Other - Org Name:MARGARET A. FULTON, PH.D., ABPP, LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ALYSSA
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-204-9667
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-204-9667
Mailing Address - Fax:
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 1450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-204-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1386778017OtherNPI INDIVIDUAL PROVIDER NUMBER