Provider Demographics
NPI:1417023540
Name:FULTON, TRACY ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:FULTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3608
Mailing Address - Country:US
Mailing Address - Phone:559-233-3373
Mailing Address - Fax:559-385-7375
Practice Address - Street 1:1495 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3608
Practice Address - Country:US
Practice Address - Phone:559-233-3373
Practice Address - Fax:559-385-7375
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist