Provider Demographics
NPI:1336940022
Name:FULLER COUNSELING AND EDUCATIONAL RESOURCES LLC
Entity type:Organization
Organization Name:FULLER COUNSELING AND EDUCATIONAL RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ASSOCIATE LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:256-452-7024
Mailing Address - Street 1:174 COUNTY ROAD 66
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-6287
Mailing Address - Country:US
Mailing Address - Phone:256-452-7024
Mailing Address - Fax:
Practice Address - Street 1:55 BRANDT PL
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1428
Practice Address - Country:US
Practice Address - Phone:256-452-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty