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General NPI Number Information
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NPI Number | 1770305203
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Entity Type | Individual
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Provider Name | CRYSTAL LEE FULTZ
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Gender |
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 546 DIXON DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78408-2916
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Country | US
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Telephone | 361-945-3846
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 AGNES ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78401-3226
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Country | US
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Telephone |
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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