Individual
DWIGHT E FULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LP
Contact information
Practice address
1003 HOLLINGER ST, PARK RAPIDS, MN 56470-1300
(218) 366-2636
(218) 366-2087
Mailing address
2310 S LAKE IRVING DR SW, BEMIDJI, MN 56601-8859
(218) 751-1811
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4277
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP4277
STATE OF MINNESOTA - MINNESOTA BOARD OF PSYCHOLOGY
MN
Enumeration date
09/25/2017
Last updated
09/25/2017
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