Provider Demographics
NPI:1417778325
Name:LIZ FULTZ, LLC
Entity type:Organization
Organization Name:LIZ FULTZ, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-230-9999
Mailing Address - Street 1:2676 STATE HIGHWAY 1654
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:KY
Mailing Address - Zip Code:41168-8949
Mailing Address - Country:US
Mailing Address - Phone:309-807-6095
Mailing Address - Fax:
Practice Address - Street 1:1505 CARTER AVE STE 104
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7672
Practice Address - Country:US
Practice Address - Phone:606-230-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598419285OtherCOUNSELOR