Provider Demographics
NPI:1619770955
Name:FULLMER, KATELYNN S (PLPC)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:S
Last Name:FULLMER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 PEERY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-1300
Mailing Address - Country:US
Mailing Address - Phone:816-554-4391
Mailing Address - Fax:
Practice Address - Street 1:2659 PEERY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1300
Practice Address - Country:US
Practice Address - Phone:816-554-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025010378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional