Provider Demographics
NPI:1669505103
Name:FULTZ, SHARON LEE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:FULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ANNE
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:3117 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-9792
Mailing Address - Country:US
Mailing Address - Phone:812-285-1874
Mailing Address - Fax:
Practice Address - Street 1:1562 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1155
Practice Address - Country:US
Practice Address - Phone:502-458-5277
Practice Address - Fax:502-459-6769
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health