Provider Demographics
NPI:1487336491
Name:FOX-FULLER, KATELYN ASHLEE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ASHLEE
Last Name:FOX-FULLER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:ASHLEE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4051 COLFAX CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-0033
Mailing Address - Country:US
Mailing Address - Phone:856-275-8774
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1742
Practice Address - Country:US
Practice Address - Phone:734-263-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0107431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical