Individual
JANE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1855 LAKELAND DR STE R305, JACKSON, MS 39216-4954
(601) 982-5376
(601) 982-5377
Mailing address
1855 LAKELAND DR STE R305, JACKSON, MS 39216-4954
(601) 982-5376
(601) 982-5377
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2124
MS
Other
Enumeration date
11/09/2016
Last updated
11/09/2016
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