Organization
FULLRIEDE PROFESSIONAL COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY FAE FULLRIEDE LCPC (PRESIDENT)
(815) 584-6383
Entity
Organization
Contact information
Practice address
2404 E EMPIRE ST # 110, BLOOMINGTON, IL 61704-3630
(815) 584-6383
Mailing address
2404 E EMPIRE ST STE 110, BLOOMINGTON, IL 61704-3630
(815) 584-6383
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/23/2026
Last updated
05/23/2026
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