Doctor Name: | MR. MICHAEL HUGH FULKERSON |
NPI Number: | 1033524236 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MAE, LPCC |
License Number: | KY - 0223 |
Business Practice Address: | 1100 Walnut St Owensboro, KY - 423012956 |
Business Phone Number: | 2706896681 |
Business Fax Number: | 2706896677 |
Mailing Address: | 3731 Frederica St, OWENSBORO |
State: | KY |
Postal Code: | 423016975 |
Phone Number: | 2706896681 |
Fax Number: | 2706896677 |
NPI Enumeration Date: | 06/25/2014 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | KY - 0223 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |