Individual
ALIA BONNIE FULLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
100 S IOWA AVE, FRUITLAND, ID 83619-2644
(541) 249-5111
Mailing address
PO BOX 836, ONTARIO, OR 97914-0836
(541) 249-5111
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9162
ID
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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