Individual
MS. KRISTINA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1048 ASHLEY ST, BOWLING GREEN, KY 42103-2449
(270) 904-6567
(270) 904-6570
Mailing address
431 CLAYPOOL BOYCE RD, ALVATON, KY 42122-8732
(270) 791-8189
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
104177
KY
101YM0800X
Mental Health Counselor
KY0572
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100287000
—
KY
Enumeration date
03/08/2014
Last updated
07/15/2019
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