Provider Demographics
NPI:1902971286
Name:FULTON, RICHARD HARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARRY
Last Name:FULTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 GOLFSIDE DR
Mailing Address - Street 2:SUITE 4 S
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1881
Mailing Address - Country:US
Mailing Address - Phone:904-730-7575
Mailing Address - Fax:
Practice Address - Street 1:9140 GOLFSIDE DR
Practice Address - Street 2:SUITE 4 S
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1881
Practice Address - Country:US
Practice Address - Phone:904-730-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist