Provider Demographics
NPI:1699234286
Name:DENNA FULTON LCSW LLC
Entity type:Organization
Organization Name:DENNA FULTON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW CADCIII MAC
Authorized Official - Phone:541-632-4800
Mailing Address - Street 1:923 E 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4352
Mailing Address - Country:US
Mailing Address - Phone:541-232-3555
Mailing Address - Fax:
Practice Address - Street 1:345 W 13TH AVE RM 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3483
Practice Address - Country:US
Practice Address - Phone:541-632-4800
Practice Address - Fax:541-632-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty