Provider Demographics
NPI:1831888908
Name:MICHELLE FULKS, MFT APC
Entity type:Organization
Organization Name:MICHELLE FULKS, MFT APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:858-775-8500
Mailing Address - Street 1:1901 1ST AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-0300
Mailing Address - Country:US
Mailing Address - Phone:858-775-8500
Mailing Address - Fax:858-724-3670
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:858-775-8500
Practice Address - Fax:858-724-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty