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Deactivated NPI 1972664852 Deactivated / Inactive NPI Male Practitioner

Dan J Fulk , LICENSED CLINICAL PR

Psychologist - Counseling • Decatur, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dan Fulk has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 13, 2006
NPI Deactivation Date March 20, 2017
Total Practice Duration ~11 Years of Practice (2006 – 2017)

Professional Overview & Biography Verified Profile Summary

Dan Fulk, LICENSED CLINICAL PR was a registered Psychologist - Counseling practicing in Decatur, IL. Throughout an active medical career spanning 11 years, Dan Fulk provided care at the practice location at 1770 E LAKE SHORE DR until profile deactivation on 2017-03-20.

Practice Location & Contact Primary Location

Practice Address

1770 E Lake Shore Dr
Suite 208

Decatur, IL 62521

Telephone 2174281900
Fax 2174280358
Associated Practice Facility / Clinic
🏢 Decatur Healthcare Llc Facility NPI 1235107939

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Counseling in Decatur, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.6 Yrs
Regional Practice Density
1 Specialists

Practicing in Decatur, IL (124 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist - Counseling Primary Specialty

NUCC Taxonomy Code: 103TC1900X

A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Charles Kerwin , LCSW, CADC

Social Worker - Clinical

NPI 1063706497

Licensed Clinical Social Worker, Certified Alcohol and Drug Counselor

Rebecca Birk , MA LCPC

Counselor - Professional

NPI 1235284464

MALCPC

Dr. Choudary Kavuri , MD

Counselor - Mental Health

NPI 1770642159

Doctor of Medicine (M.D.)

Jennifer Hortenstine-Grohler , LCPC

Counselor - Professional

NPI 1780807222

Licensed Clinical Professional Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 20, 2017

Record deactivated on March 20, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1770 E LAKE SHORE DR, SUITE 208, DECATUR, IL 62521 (Tel: 2174281900)

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Updated Business Mailing Address July 08, 2007

Registered at 1770 E LAKE SHORE DR, SUITE 208, DECATUR, IL 62521 (Tel: 2174281900)

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Provider Name / Credentials Updated July 08, 2007

Recorded as DAN FULK, LICENSED CLINICAL PR

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Psychologist

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Initial NPI Registration & Enumeration December 13, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1972664852
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 13, 2006
Last Update: July 08, 2007
Deactivation Date: March 20, 2017

Mailing Address

1770 E Lake Shore Dr, Suite 208

Decatur, IL 62521

Phone: 2174281900

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.