Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | C1400512 | OH |
NPI | 1003309774 |
---|---|
Provider Name | Shelli Fullum |
First Address | Akron, OH 44303-1406 |
Second Address | Akron, OH 44303-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |