Individual ProviderAndy Leroy FultonCounselorBehavioral Health & Social Service ProvidersPractice Address1901 Cleveland Avenue, #B, Santa Rosa, CA 95401(707) 576-0818PECOS EnrollmentBased on the most recent information from CMS, provider Andy Leroy Fulton does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1265864821Provider TypeIndividualFull NameFulton, Andy LeroyTitleMr.CredentialRASGenderMaleSole ProprietorNoEnumeration Date8/6/2013Last Updated8/6/2013Contact InformationPractice LocationPractice Address1901 Cleveland Avenue, #B, Santa Rosa, CA 95401Phone(707) 576-0818Fax(707) 576-7845Mailing LocationMailing Address1901 Cleveland Avenue #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401Phone(707) 576-0818Fax(707) 576-7845Provider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseF1101261615California