Provider Demographics
NPI:1982623609
Name:FULLEN, KAREN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:FULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4520
Mailing Address - Country:US
Mailing Address - Phone:870-972-1268
Mailing Address - Fax:
Practice Address - Street 1:1217 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4520
Practice Address - Country:US
Practice Address - Phone:870-972-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1662-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W981OtherBLUECROSS PROVIDER NUMBER
AR5W981Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER