Provider Demographics
NPI:1205228178
Name:FULTON, LORI MELINDA (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MELINDA
Last Name:FULTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 10073
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:936-229-5426
Mailing Address - Fax:
Practice Address - Street 1:1225 COUNTY ROAD 522
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-8311
Practice Address - Country:US
Practice Address - Phone:936-229-5426
Practice Address - Fax:888-872-4045
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66513101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional