Active NPI
Stephanie Fulgencio, LMFT
- Marriage & Family Therapist
- Dallas, TX
National Provider Identifier
1558790535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 201320
- Practice address
- 18725 Dallas Pkwy
Dallas, TX 75287-4239 - Phone
- (972) 689-4434
- NPI assigned
- Nov 11, 2013
- Reactivated
- Aug 3, 2021
- Last updated
- Aug 3, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 201320 | TX | Primary |
Addresses
Primary practice location
18725 Dallas Pkwy
Dallas, TX 75287-4239
Mailing address
18725 Dallas Pkwy Apt 321
Dallas, TX 75287-4240
Phone (972) 689-4434
Other practice location 1
3613 Frankford Rd
Dallas, TX 75287-6137
Phone (940) 297-7393
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 15, 2024 through Jan 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201320 | TX | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627948800000",
"number": "1558790535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18725 DALLAS PKWY APT 321",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874240",
"telephone_number": "972-689-4434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18725 DALLAS PKWY",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874239",
"telephone_number": "972-689-4434"
}
],
"practiceLocations": [
{
"address_1": "3613 Frankford Rd",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "TX",
"postal_code": "752876137",
"country_code": "US",
"telephone_number": "940-297-7393",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULGENCIO",
"first_name": "STEPHANIE",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-11",
"last_updated": "2021-08-03",
"certification_date": "2021-08-03",
"deactivation_date": "2015-05-22",
"reactivation_date": "2021-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "TX",
"license": "201320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Jody Lee Fulbright, L.P.C.
- Richard L Fulbright, PH.D.
- Grace Anne Fulcher, M.S., CCC-SLP
- Richard Fuld III, MD
- Jeana Elizabeth Fulenwider, PT, DPT
- Angela K Fulgham-Gardner, MD
- Pat Fox Fulgham, M.D.
- Dawn Maria Fulghum, LPTA
- Full Circle Counseling and Family Services, PLLC
- Full Life Outreach Medical Center LLC (Full Life Outreach Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.