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Organization
FULLER LIFE CONCEPTS
Active
Organization
FULLER LIFE CONCEPTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM FULLER LMFT (CEO)
(323) 336-2294
Entity
Organization
Contact information
Practice address
5150 CANDLEWOOD ST STE 18C, LAKEWOOD, CA 90712-1927
(323) 334-0064
Mailing address
PO BOX 7402, LONG BEACH, CA 90807-0402
(323) 334-0064
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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