Individual
CRYSTAL LEE FULTZ
Active
Individual
CRYSTAL LEE FULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103TE1000X
BEHAVIORAL/SOCIAL PSYCHOLOGY
—
01
—
1780079319
101Y00000X
—
Enumeration date
10/28/2024
Last updated
02/02/2025
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