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General NPI Number Information
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NPI Number | 1073979662
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Entity Type | Individual
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Provider Name | LAUREL ANN FULLINGTON M.A.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 630 SW 149TH ST SUITE 101
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City | BURIEN
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State | WA
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Zip | 98166-1901
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Country | US
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Telephone | 206-612-0665
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Fax | 206-244-0253
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Provider Business Mailing Address
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Address Line | 630 SW 149TH ST SUITE 101
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City | BURIEN
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State | WA
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Zip | 98166-1901
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Country | US
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Telephone | 206-612-0665
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Fax | 206-244-0253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LH60544439
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License Number State | WA
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