Individual provider · Type 1 NPI

Shantel Azure Fuller

Addiction (Substance Use Disorder) Counselor · Gresham, OR

NPI number 1629240288 Active

Practice location

400 NE 7th St
Gresham, OR 97030-5604

Call (503) 661-5455 Map

Mailing address

10625 SE 362nd Ave Unit C8
Boring, OR 97009-9746

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1629240288

Shantel Azure Fuller's National Provider Identifier is 1629240288, issued on Mar 24, 2008. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Gresham, OR. The record was last updated on Mar 24, 2008.