Individual ProviderAshanta FulmoreCounselorBehavioral Health & Social Service ProvidersPractice Address6600 W Charleston Blvd, Ste. 140, Las Vegas, NV 89146(702) 440-8440PECOS EnrollmentBased on the most recent information from CMS, provider Ashanta Fulmore is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861053142Provider TypeIndividualFull NameFulmore, AshantaGenderFemaleSole ProprietorNoEnumeration Date6/26/2019Last Updated10/9/2024Contact InformationPractice LocationPractice Address6600 W Charleston Blvd, Ste. 140, Las Vegas, NV 89146Phone(702) 440-8440FaxUnlisted FaxMailing LocationMailing Address6600 W Charleston Blvd, Ste. 140, Las Vegas, NV 89146PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerCode225400000XDescriptionRehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted Issuer