Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor |
NPI | 1154725315 |
---|---|
Provider Name | Mr. Fred Fulton IV |
First Address | West Monroe, LA 71291-5401 |
Second Address | Delhi, LA 71232-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 02/06/2021 |