Provider Demographics
NPI:1699053124
Name:FULTS, DEVON NICOLE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:NICOLE
Last Name:FULTS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:DEVON
Other - Middle Name:NICOLE
Other - Last Name:FRAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7980 ANCHOR DRIVE
Mailing Address - Street 2:BUILDING 500
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8285
Mailing Address - Country:US
Mailing Address - Phone:409-727-6400
Mailing Address - Fax:409-727-6403
Practice Address - Street 1:7980 ANCHOR DRIVE
Practice Address - Street 2:BUILDING 500
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8285
Practice Address - Country:US
Practice Address - Phone:409-727-6400
Practice Address - Fax:409-727-6403
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional