| Doctor Name: | JESSICA LANDRY FULTZ |
| NPI Number: | 1417264169 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 11307 |
| Business Practice Address: | 221 N Monroe St Suite B Marksville, LA - 713512311 |
| Business Phone Number: | 3183059210 |
| Business Fax Number: | |
| Mailing Address: | Po Box 65, HESSMER |
| State: | LA |
| Postal Code: | 713410065 |
| Phone Number: | 3183059210 |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2010 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 11307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |