1699234286 NPI number — DENNA FULTON LCSW LLC

Table of content: MISS TAKESHA LYNN WALKER LLP, CCS, CADC (NPI 1881851533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699234286 NPI number — DENNA FULTON LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENNA FULTON LCSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699234286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 E 36TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405-4352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-232-3555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 W 13TH AVE RM 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-632-4800
Provider Business Practice Location Address Fax Number:
541-632-4810
Provider Enumeration Date:
03/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FULTON
Authorized Official First Name:
DENNA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
541-632-4800

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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