Provider Demographics
NPI:1356671879
Name:FULTON, LEIGHANNA R (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LEIGHANNA
Middle Name:R
Last Name:FULTON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BRIDGEWAY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4017
Mailing Address - Country:US
Mailing Address - Phone:870-215-8729
Mailing Address - Fax:
Practice Address - Street 1:315 S COLLEGE RD STE 220
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3221
Practice Address - Country:US
Practice Address - Phone:337-456-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional