Provider Demographics
NPI:1356424956
Name:FULTON, KAREN JEAN (MACP, LMHC, CEAP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JEAN
Last Name:FULTON
Suffix:
Gender:F
Credentials:MACP, LMHC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 FORTUNE PKWY
Mailing Address - Street 2:UNIT 504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6746
Mailing Address - Country:US
Mailing Address - Phone:904-363-6999
Mailing Address - Fax:904-363-6996
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:UNIT 504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-363-6999
Practice Address - Fax:904-363-6996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002651101YA0400X, 101YM0800X
FLMH2651101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2651OtherLIC MENTAL HEALTH COUNSEL