Individual
BETHANY RAE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
260 CLARKSON RD, ELLISVILLE, MO 63011-2245
(314) 254-3448
Mailing address
3931 WYOMING ST, SAINT LOUIS, MO 63116-3917
(312) 505-8141
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2022003037
MO
Other
Enumeration date
04/30/2025
Last updated
04/30/2025
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