Healthcare Provider Details

I. General information

NPI: 1699234286
Provider Name (Legal Business Name): DENNA FULTON LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 13TH AVE RM 2
EUGENE OR
97401-3483
US

IV. Provider business mailing address

923 E 36TH AVE
EUGENE OR
97405-4352
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-4800
  • Fax: 541-632-4810
Mailing address:
  • Phone: 541-232-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DENNA MARIE FULTON
Title or Position: OWNER/THERAPIST
Credential: MSW LCSW CADCIII MAC
Phone: 541-632-4800