Individual
MRS. KATIE ANN SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHA
Contact information
Practice address
4630 W JEFFERSON BLVD STE 3, FORT WAYNE, IN 46804-6800
(260) 632-2131
Mailing address
5709 N STATE ROAD 101, WOODBURN, IN 46797-9655
(260) 257-0016
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88002538A
IN
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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