Provider Demographics
NPI:1639384571
Name:FULTZ, JANET KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:KATHLEEN
Last Name:FULTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 W. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-612-3196
Mailing Address - Fax:405-377-3499
Practice Address - Street 1:2224 W. 12TH STREET
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-612-3196
Practice Address - Fax:405-377-3499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2967101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health