Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1265772867 |
---|---|
Provider Name | Tara Fulkerson |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40218-3495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 05/05/2014 |