Provider Demographics
NPI:1548535537
Name:KAREN FULTON LMHC, INC
Entity type:Organization
Organization Name:KAREN FULTON LMHC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MACP, LMHC, CEAP
Authorized Official - Phone:904-363-6999
Mailing Address - Street 1:10175 FORTUNE PKWY
Mailing Address - Street 2:UNIT 504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6746
Mailing Address - Country:US
Mailing Address - Phone:904-363-6999
Mailing Address - Fax:904-363-6996
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:UNIT 504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-363-6999
Practice Address - Fax:904-363-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty