Individual
JULIE FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
91150 N COBURG INDUSTRIAL WAY, COBURG, OR 97408-9512
(541) 687-1110
Mailing address
91150 N COBURG INDUSTRIAL WAY, COBURG, OR 97408-9512
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
309-019-0125
OR
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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