MEDICARE: DEBRA L FULTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	77918	TX

General Provider Information

NPI Number	:	1477384543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA L FULTON LPC

Provider Business Mailing Address
First Line	:	1309 DUNBARTON DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5916
Country	:	US
Telephone Number	:	817-528-3580
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 N CENTRAL EXPY STE 510
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1842
Country	:	US
Telephone Number	:	469-987-8522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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