Crystal Rayne Fulton, LPC, LCDC – Counselor

Key facts

NPI: 1548099419
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
License: 88978 (TX)
Practice address: 1224 Southridge
Salado, TX 76571-5801
Phone: (972) 983-9577
NPI assigned: Jul 30, 2024
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
88978	TX	MD	Counselor
15716	TX	MD	Addiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) Counselor	101YA0400X	15716	TX
Counselor	101Y00000X	88978	TX	Yes

Addresses

Primary practice location

1224 Southridge
Salado, TX 76571-5801

Mailing address

1224 Southridge
Salado, TX 76571-5801
Phone (972) 983-9577

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 30, 2024.

{
    "created_epoch": "1722297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1548099419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 SOUTHRIDGE",
            "city": "SALADO",
            "state": "TX",
            "postal_code": "765715801",
            "telephone_number": "972-983-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 SOUTHRIDGE",
            "city": "SALADO",
            "state": "TX",
            "postal_code": "765715801",
            "telephone_number": "972-983-9577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "CRYSTAL",
        "middle_name": "RAYNE",
        "name_prefix": "Miss",
        "credential": "LPC, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "15716",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "88978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salado, TX

All providers in Salado, TX · Counselor in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.