Provider Demographics
NPI:1235323015
Name:FULWOOD, CHRISTI (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTI
Middle Name:
Last Name:FULWOOD
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MRS
Other - First Name:CHRISTI
Other - Middle Name:
Other - Last Name:BRANDENSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:2625 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1003
Mailing Address - Country:US
Mailing Address - Phone:314-776-1228
Mailing Address - Fax:
Practice Address - Street 1:3309 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1101
Practice Address - Country:US
Practice Address - Phone:314-534-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008630101YP2500X
TN1600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional