Provider Demographics
NPI:1861694697
Name:FULWILER, MICHELLE LANAE (LMHC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LANAE
Last Name:FULWILER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LH60068722
Mailing Address - Street 1:29613 21ST PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4250
Mailing Address - Country:US
Mailing Address - Phone:206-931-4752
Mailing Address - Fax:
Practice Address - Street 1:29613 21ST PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4250
Practice Address - Country:US
Practice Address - Phone:206-931-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00054043101YP2500X
WALH60068722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional