=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871822809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULLY EFFECTIVE EMPLOYEES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2009
-----------------------------------------------------
Last Update Date | 12/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 LAKE BELLEVUE DR STE 100
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-2480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-454-3003
-----------------------------------------------------
Fax | 425-642-8808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 ISSAQUAH PINE LAKE RD SE # 315
-----------------------------------------------------
City | SAMMAMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98075-7253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-454-3003
-----------------------------------------------------
Fax | 425-642-8808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. AUDREY KIM ROSENFELD
-----------------------------------------------------
Credential | LICSW, CEAP
-----------------------------------------------------
Telephone | 425-557-0907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------