Provider Demographics
NPI:1821844192
Name:MOLLIE FULTZ COUNSELING & THERAPY SERVICES LLC
Entity type:Organization
Organization Name:MOLLIE FULTZ COUNSELING & THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-509-6367
Mailing Address - Street 1:883 MILLBRAE CT UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8467
Mailing Address - Country:US
Mailing Address - Phone:317-509-6367
Mailing Address - Fax:
Practice Address - Street 1:883 MILLBRAE CT UNIT 6
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8467
Practice Address - Country:US
Practice Address - Phone:317-509-6367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)