Individual
TEEA R FULLEN-BARNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCA, LAT, ATC
Contact information
Practice address
6500 GLENRIDGE PARK PL STE 8, LOUISVILLE, KY 40222-3450
(502) 303-2449
Mailing address
341 CUNNINGHAM LN, WINCHESTER, KY 40391-7450
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
280487
KY
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/08/2019
Last updated
09/06/2023
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