KENNETH FULTZ


Address: 15941 Fairfield St, Detroit, MI 48238-4123
Phone: 3133454310

KENNETH FULTZ (NPI# 1023574787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1023574787
Entity Type Individual
Full Name KENNETH FULTZ
Credential CPRM
Practice Address 15941 Fairfield St
Detroit
MI 48238-4123
Practice Telephone 3133454310
Practice Fax Number 3133454315
Mailing Telephone 3133454310
Mailing Fax Number 3133454315
Enumeration Date 2019-02-18
Last Update Date 2019-02-18
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 175T00000X Peer Specialist Other Service Providers

Office Location

Street Address 15941 FAIRFIELD ST
City DETROIT
State MI
Zip Code 48238-4123

Providers in the same location

NPI Name Taxonomy Address Enumeration
1144469461 Lakeridge Village, Inc. Substance Abuse Rehabilitation Facility 15941 Fairfield St, Detroit, MI 48238-4123 2009-02-10
1134739501 Lakeridge Village, Inc Substance Abuse Rehabilitation Facility 15941 Fairfield St, Detroit, MI 48238-4123 2020-07-31
1548886732 Eugenia Holimon Counselor 15941 Fairfield St, Detroit, MI 48238-4123 2020-06-23
1790301992 Gayle Lowe Counselor 15941 Fairfield St, Detroit, MI 48238-4123 2020-06-23
1134745995 Juanita Charleston Contractor 15941 Fairfield St, Detroit, MI 48238-4123 2020-06-17
1023587359 Megan E Doyle Peer Specialist 15941 Fairfield St, Detroit, MI 48238-4123 2018-11-15
1104309509 Jonathon Edward Williams Counselor 15941 Fairfield St, Detroit, MI 48238-4123 2018-09-11
1487130555 Rodney Johnson Peer Specialist 15941 Fairfield St, Detroit, MI 48238-4123 2018-07-12
1255817458 Gina Smith Peer Specialist 15941 Fairfield St, Detroit, MI 48238-4123 2018-07-11
1275047797 Terrence Edward Jones Peer Specialist 15941 Fairfield St, Detroit, MI 48238-4123 2017-11-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1700372224 Cardinal Home Healthcare Group, LLC Home Health 3165 Oakman Boulvard, Detroit, MI 48238 2018-07-09
1063963684 Lydia Adkins Counselor 13505 Lasalle St, Apt 305, Detroit, MI 48238 2016-10-19
1750837324 A Plus Care Transportation LLC Clinic/Center 14586 Wisconsin, Detroit, MI 48238 2016-09-01
1518413756 Valarie Grayer - Felton Case Manager/Care Coordinator 15941 Fairfield St., Detroit, MI 48238 2016-08-28
1144773722 Juanna Cherise Hardaway Case Manager/Care Coordinator 1935 Pasadena, Detroit, MI 48238 2016-07-29
1336503556 Gladys S Chambers Home Health Aide 15473 Wisconsin, Detroit, MI 48238 2016-04-13
1891158788 Karla Gill Licensed Practical Nurse 153060 Wildemere, Detroit, MI 48238 2016-03-30
1790145548 Cecil Cosey IIi Psychologist 11000 W Micnichols, Detroit, MI 48238 2016-03-07
1508264102 Sav-med Pharmacy Inc Pharmacy 2645 West Davison, Detroit, MI 48238 2014-12-12
1760887020 Monument Dental PC Dentist 15510 Livernois Avenue, Detroit, MI 48238 2014-10-29
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Taxonomy Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Notes: Source: National Uniform Claim Committee [7/1/2014: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1992355135 James Calloway Peer Specialist 1211 E Mcnichols, Detroit, MI 48203 2019-09-19
1790331536 Bridgett Darcell Scott Peer Specialist 1121 E 6 Mile Rd, Detroit, MI 48203-2857 2019-08-16
1932669827 Donald Brown Peer Specialist 18582 Goddard St, Detroit, MI 48234-1319 2019-03-25
1710463880 Felicia Greene Peer Specialist 3542 Fairview St, Detroit, MI 48214-3539 2018-07-12
1033603998 Tonya Patrice Miller-cherry Peer Specialist 1423 Field St # 5, Detroit, MI 48214-2321 2018-06-14
1831612662 Heidi L Brinkley Peer Specialist 5575 Conner St Ste 204b, Detroit, MI 48213-6401 2017-07-24
1588067383 Katrina Baldwin Peer Specialist 11668 Montrose St, Detroit, MI 48227-1758 2014-10-07
1700498771 Darryl Angelo Walker Peer Specialist 1145 W Grand Blvd, Detroit, MI 48208-2336 2020-08-20
1487266441 Jeremiah Spears Jr. Peer Specialist 1121 E Mcnichols Rd, Detroit, MI 48203-2857 2020-08-20
1740892603 Sheena Talanya Dalton Peer Specialist 1121 E Mcnichols Rd, Detroit, MI 48203-2857 2020-08-20
Find all providers in DETROIT

Competitor

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City DETROIT
Zip Code 48238

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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