Provider Demographics
NPI:1063938850
Name:BACKER-FULGHUM, LINDSEY MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MARIE
Last Name:BACKER-FULGHUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S PRESCOTT CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WICHITA STATE UNIVERSITY, COUNSELING & TESTING CENTER
Practice Address - Street 2:1845 FAIRMOUNT ST.
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-0091
Practice Address - Country:US
Practice Address - Phone:573-220-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMLP2799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical