Organization
FULLER COUNSELING GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER FULLER LCPC (MANAGING PARTNER)
(773) 310-1583
Entity
Organization
Contact information
Practice address
5100 N RAVENSWOOD AVE STE 233, CHICAGO, IL 60640-1752
(773) 310-1583
(773) 664-0828
Mailing address
5100 N RAVENSWOOD AVE STE 233, CHICAGO, IL 60640-1752
(773) 310-1583
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740429596
NPPES
IL
Enumeration date
06/09/2017
Last updated
07/21/2022
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