Doctor Name: | MRS. MELISHA KANISH FULTZ |
NPI Number: | 1144668294 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS. LPC. |
License Number: | |
Business Practice Address: | 1013 E 66th Pl Tulsa, OK - 741363701 |
Business Phone Number: | 9182932500 |
Business Fax Number: | 9182932581 |
Mailing Address: | 5109 S Madison Ave, Apartment 146 TULSA |
State: | OK |
Postal Code: | 741055682 |
Phone Number: | 9188561915 |
Fax Number: | 9182932581 |
NPI Enumeration Date: | 06/11/2013 |
NPI Last Update Date: | 08/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |