Provider Demographics
NPI:1417414525
Name:FOREST PATH COUNSELING & WELLNESS LISA FULFOR PLLC
Entity Type:Organization
Organization Name:FOREST PATH COUNSELING & WELLNESS LISA FULFOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULFOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-316-0924
Mailing Address - Street 1:13254 LIME RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0938
Mailing Address - Country:US
Mailing Address - Phone:214-316-0924
Mailing Address - Fax:
Practice Address - Street 1:8105 RASOR BLVD STE 225
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0265
Practice Address - Country:US
Practice Address - Phone:214-316-0924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty