Individual
CAROL FULLERTON MYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
972 PICO PT, COLORADO SPRINGS, CO 80905-7380
(719) 640-7630
Mailing address
972 PICO PT, COLORADO SPRINGS, CO 80905-7380
(719) 640-7630
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4259
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11831642
CAQH
CO
Enumeration date
03/17/2010
Last updated
03/17/2010
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