Provider Demographics
NPI:1265203111
Name:FULFORD, TROY (MDIV, MA, MFT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:FULFORD
Suffix:
Gender:M
Credentials:MDIV, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 BRAEWICK CIR STE 201&202
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6262
Mailing Address - Country:US
Mailing Address - Phone:234-303-2325
Mailing Address - Fax:
Practice Address - Street 1:2106 BRAEWICK CIR STE 201&202
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6262
Practice Address - Country:US
Practice Address - Phone:234-303-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2400324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist