Individual
SHAWNA FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1201 FALL AVE EAST SUITE C, TWIN FALLS, ID 83301
(208) 734-4250
(208) 734-4260
Mailing address
1201 FALL AVE EAST SUITE C, TWIN FALLS, ID 83301
(208) 734-4250
(208) 734-4260
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-34760
ID
Other
Enumeration date
03/24/2016
Last updated
03/24/2016
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