Provider Demographics
NPI:1598416703
Name:D. FULTON FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:D. FULTON FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:314-363-4136
Mailing Address - Street 1:137 N OAK PARK AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1340
Mailing Address - Country:US
Mailing Address - Phone:626-460-0707
Mailing Address - Fax:708-406-2123
Practice Address - Street 1:137 N OAK PARK AVE STE 216
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1340
Practice Address - Country:US
Practice Address - Phone:626-460-0707
Practice Address - Fax:708-406-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty