MEDICARE: FULLY EFFECTIVE EMPLOYEES, INC.

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1871822809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULLY EFFECTIVE EMPLOYEES, INC.

Provider Business Mailing Address
First Line	:	3020 ISSAQUAH PINE LAKE RD SE # 315
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-7253
Country	:	US
Telephone Number	:	425-454-3003
Fax Number	:	425-642-8808

Provider Business Practice Location Address
First Line	:	40 LAKE BELLEVUE DR STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2480
Country	:	US
Telephone Number	:	425-454-3003
Fax Number	:	425-642-8808

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. AUDREY KIM ROSENFELD
Credential	:	LICSW, CEAP
Telephone Number	:	425-557-0907

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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