Provider Demographics
NPI:1326376245
Name:FULTON, LISA (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2714
Mailing Address - Country:US
Mailing Address - Phone:816-508-3313
Mailing Address - Fax:816-508-3321
Practice Address - Street 1:8000 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2714
Practice Address - Country:US
Practice Address - Phone:816-508-3313
Practice Address - Fax:816-508-3321
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7280104100000X
MO20090017351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker