MEDICARE: SAMANTHA FULTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BH001353	PA
2	101YP2500X	Professional Counselor	PC018296	PA

General Provider Information

NPI Number	:	1952712986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA FULTON LPC

Provider Business Mailing Address
First Line	:	421 HUMMINGBIRD DR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-1335
Country	:	US
Telephone Number	:	717-575-3758
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 COPPERFIELD CIR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-9481
Country	:	US
Telephone Number	:	717-892-9283
Fax Number	:	717-220-8343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	04/01/2025

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