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General NPI Number Information
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NPI Number | 1073785234
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Entity Type | Individual
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Provider Name | RICHARD D FULTON LPC
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Gender | Male
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 07/26/2009
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Provider Practice Location Address
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Address Line | 7525 JOHN T WHITE RD
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City | FORT WORTH
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State | TX
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Zip | 76120-3311
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Country | US
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Telephone | 817-429-4769
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Fax | 817-457-7906
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Provider Business Mailing Address
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Address Line | 1605 CANFIELD DR APT 1009
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City | FORT WORTH
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State | TX
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Zip | 76120-4961
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Country | US
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Telephone | 817-296-5930
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Fax | 817-457-7908
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 18221
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18221
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License Number State | TX
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