Provider Demographics
NPI:1477919199
Name:FULTON, BETHANY L (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:FULTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:L
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:530 W UNION ST STE D
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8303
Mailing Address - Country:US
Mailing Address - Phone:740-591-6352
Mailing Address - Fax:
Practice Address - Street 1:530 W UNION ST STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8303
Practice Address - Country:US
Practice Address - Phone:740-591-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health