Individual
JILL M. FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., L.L.P.
Contact information
Practice address
43825 MICHIGAN AVE, CANTON, MI 48188-2551
(734) 397-3088
Mailing address
42658 SOMERSET DR, CANTON, MI 48187-3023
(734) 981-4285
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301012299
MI
Other
Enumeration date
03/14/2007
Last updated
07/08/2007
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