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General NPI Number Information
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NPI Number | 1235464504
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Entity Type | Individual
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Provider Name | DENNA MARIE FULTON LCSW, QMHP, CADCIII
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Gender | Female
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2073 OLYMPIC ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477
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Country | US
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Telephone | 541-682-3550
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Fax | 541-682-3551
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Provider Business Mailing Address
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Address Line | 2073 OLYMPIC ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3413
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Country | US
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Telephone | 541-682-3550
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Fax | 541-682-3551
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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 | 1309-50
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License Number State | OR
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L8032
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License Number State | OR
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