Active NPI
Mary Alice Fulghum, LMFT, L.P.C.
- Marriage & Family Therapist
- Jacksonville, FL
National Provider Identifier
1831273275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MT 2553
- Practice address
- 9791 Old Saint Augustine Rd
Jacksonville, FL 32257-6035 - Phone
- (904) 762-4040
- Fax
- (904) 238-5078
- NPI assigned
- Oct 24, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MT 2553 | FL | Primary |
| Professional Counselor | 101YP2500X | 929 | MS |
Addresses
Primary practice location
9791 Old Saint Augustine Rd
Jacksonville, FL 32257-6035
Mailing address
11996 Lazarette CT
Jacksonville, FL 32258-1197
Phone (904) 762-4040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT 2553 | FL | MD | Marriage & Family Therapist |
| 929 | MS | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337558400000",
"number": "1831273275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11996 LAZARETTE CT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322581197",
"telephone_number": "904-762-4040",
"fax_number": "904-238-5078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9791 OLD SAINT AUGUSTINE RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322576035",
"telephone_number": "904-762-4040",
"fax_number": "904-238-5078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULGHUM",
"first_name": "MARY",
"middle_name": "ALICE",
"credential": "LMFT, L.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2012-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "FL",
"license": "MT 2553",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "929",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.