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General NPI Number Information
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NPI Number | 1023870359
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Entity Type | Individual
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Provider Name | BRENDA R. FULTON LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 104 9TH AVE S STE A6
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City | NAMPA
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State | ID
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Zip | 83651-3809
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Country | US
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Telephone | 208-960-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 750 S WESTON CREEK LOOP
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City | NAMPA
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State | ID
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Zip | 83686-5655
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Country | US
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Telephone | 208-992-6530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-44566
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License Number State | ID
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