Provider Demographics
NPI:1013492396
Name:FULTON, RICHARD W II (MED, BCBA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:FULTON
Suffix:II
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6629
Mailing Address - Country:US
Mailing Address - Phone:469-520-1102
Mailing Address - Fax:
Practice Address - Street 1:1561 MEADOWS AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-6629
Practice Address - Country:US
Practice Address - Phone:469-520-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-17-32430106S00000X
TX1-18-34062103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician