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General NPI Number Information
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NPI Number | 1841738457
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Entity Type | Organization
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Legal Business Name | COPING 4 KIDS
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 900 N WALNUT ST.
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City | BREESE
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State | IL
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Zip | 62230
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Country | US
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Telephone | 618-830-5312
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N WALNUT ST.
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City | BREESE
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State | IL
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Zip | 62230
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Country | US
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Telephone | 618-830-5312
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | MS. KRIS FULKERSON
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Credential | LCSW, MSW, MS
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Telephone | 618-830-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.013537
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License Number State | IL
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