Provider Demographics
NPI:1306416003
Name:FULLER, RACHEL (MA LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22272 E TUFTS CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4733
Mailing Address - Country:US
Mailing Address - Phone:720-272-4102
Mailing Address - Fax:
Practice Address - Street 1:22272 E TUFTS CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-4733
Practice Address - Country:US
Practice Address - Phone:720-272-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1306416003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional