MEDICARE: FULLY YOU THERAPY PLLC

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
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730793712	OTHER		INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356180194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULLY YOU THERAPY PLLC

Provider Business Mailing Address
First Line	:	1651 N HARVEST PKWY UNIT B106
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5268
Country	:	US
Telephone Number	:	509-230-4068
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 N HARVEST PKWY UNIT B106
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5268
Country	:	US
Telephone Number	:	509-230-4068
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ANNA JOHNSON
Credential	:	MS, LMHC
Telephone Number	:	509-230-4068

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	06/13/2026

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