Individual
DOUGLAS RICHARD FULMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.DIV., L.C.S.W.
Contact information
Practice address
11309 DISTINCTIVE DR, SUITE #3, ORLAND PARK, IL 60467-9490
(708) 227-5184
Mailing address
14514 MALLARD DR, HOMER GLEN, IL 60491-9263
(708) 227-5184
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149013359
IL
Other
Enumeration date
05/02/2009
Last updated
05/02/2009
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