Provider Demographics
NPI:1982469722
Name:FULLETON COUNSELING
Entity Type:Organization
Organization Name:FULLETON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-249-5111
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0836
Mailing Address - Country:US
Mailing Address - Phone:541-249-5111
Mailing Address - Fax:
Practice Address - Street 1:100 S IDAHO AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619
Practice Address - Country:US
Practice Address - Phone:541-249-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty