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Individual

MR. JAKE E FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
142 E MAUMEE ST STE 3, ADRIAN, MI 49221-2735
(312) 718-4221
Mailing address
112 W SHAWNEE ST, TECUMSEH, MI 49286-1566
(312) 718-4221

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YP2500X
Professional Counselor
Primary
6401226147
MI

Other

Enumeration date
03/21/2024
Last updated
04/13/2026
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