Healthcare Provider Details

I. General information

NPI: 1952966954
Provider Name (Legal Business Name): DEVIN L FULTON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 W SMITH VALLEY RD
GREENWOOD IN
46142-8495
US

IV. Provider business mailing address

3209 W SMITH VALLEY RD
GREENWOOD IN
46142-8495
US

V. Phone/Fax

Practice location:
  • Phone: 317-936-1240
  • Fax: 317-936-1241
Mailing address:
  • Phone: 317-936-1240
  • Fax: 317-936-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number95001413A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: