Individual
ELLEN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW, QMRP, QMHP
Contact information
Practice address
789 N CLARE AVE, HARRISON, MI 48625-9194
(989) 539-2141
(989) 539-2143
Mailing address
789 N CLARE AVE, HARRISON, MI 48625-9194
(989) 539-2141
(989) 539-2143
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802060717
MI
Other
Enumeration date
01/02/2014
Last updated
01/02/2014
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