Provider Demographics
NPI:1356180194
Name:FULLY YOU THERAPY
Entity type:Organization
Organization Name:FULLY YOU THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:509-230-4068
Mailing Address - Street 1:506 N VERCLER RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-7005
Mailing Address - Country:US
Mailing Address - Phone:509-230-4068
Mailing Address - Fax:
Practice Address - Street 1:506 N VERCLER RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-7005
Practice Address - Country:US
Practice Address - Phone:509-230-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730793712OtherINDIVIDUAL NPI
WA2163747Medicaid