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NPI Code Detail

MEDICARE: SARAH FULLER LPC - 6401223002

MEDICARE:   SARAH  FULLER  LPC - 6401223002
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6401223002MI
2101YA0400XAddiction (Substance Use Disorder) Counselor6401223002MI
3101YP2500XProfessional Counselor6401223002MI

General Provider Information

NPI Number : 1477176907
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH FULLER LPC - 6401223002
Provider Business Mailing Address
First Line : 201 N MITCHELL ST STE 204
Second Line :
City : CADILLAC
State : MI
Zip : 49601-1859
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 N MITCHELL ST STE 204
Second Line :
City : CADILLAC
State : MI
Zip : 49601-1859
Country : US
Telephone Number : 231-884-0028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2020
Last Update Date : 01/07/2026

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Directions to “ SARAH FULLER LPC - 6401223002” Practice Location

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