Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MH0002651 | FL |
Y | 101YM0800X | Mental Health Counselor | MH0002651 | FL |
N | 101YP1600X | Pastoral Counselor | MH2651 | FL |
NPI | 1356424956 |
---|---|
Provider Name | Mrs. Karen Jean Fulton |
First Address | Jacksonville, FL 32256-6746 |
Second Address | Jacksonville, FL 32256-6746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2651 | LIC MENTAL HEALTH COUNSEL (01) | FL |