Healthcare Provider Details

I. General information

NPI: 1790653129
Provider Name (Legal Business Name): JENNIFER FULLER LPCC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 HILLTOP PKWY UNIT 204
STEAMBOAT SPRINGS CO
80487-3176
US

IV. Provider business mailing address

PO BOX 538
OAK CREEK CO
80467-0538
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-4332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024063
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002847
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: