Provider Demographics
NPI:1841738457
Name:COPING 4 KIDS
Entity Type:Organization
Organization Name:COPING 4 KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, MS
Authorized Official - Phone:618-830-5312
Mailing Address - Street 1:900 N WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230
Mailing Address - Country:US
Mailing Address - Phone:618-830-5312
Mailing Address - Fax:
Practice Address - Street 1:900 N WALNUT ST.
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230
Practice Address - Country:US
Practice Address - Phone:618-830-5312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0135371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty