Individual
MACKENZIE FULLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
321 E MAIN ST STE 207, BOZEMAN, MT 59715-4731
(406) 209-4928
Mailing address
10542 PO BOX, BOZEMAN, MT 59719
(406) 209-4928
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-70738
MT
Other
Enumeration date
01/24/2022
Last updated
10/31/2024
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