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General NPI Number Information
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NPI Number | 1558918839
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Entity Type | Individual
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Provider Name | DANIEL P FULTON MA
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Gender | Male
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 137 N OAK PARK AVE STE 216
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City | OAK PARK
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State | IL
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Zip | 60301-1340
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Country | US
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Telephone | 626-460-0707
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Fax | 708-406-2123
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Provider Business Mailing Address
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Address Line | 137 N OAK PARK AVE STE 216
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City | OAK PARK
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State | IL
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Zip | 60301-1340
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Country | US
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Telephone | 626-460-0707
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Fax | 708-406-2123
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001589
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 124641
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License Number State | CA
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