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Organization
FULLER BEHAVIOR PROGRAM
Active
Organization
FULLER BEHAVIOR PROGRAM
Active
Other names
Fuller Behavior Program
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN FULLER (CEO)
(214) 760-9573
Entity
Organization
Contact information
Practice address
2803 RIVERSIDE PKWY APT 4502, GRAND PRAIRIE, TX 75050-8747
(214) 760-9573
Mailing address
2803 RIVERSIDE PKWY APT 4502, GRAND PRAIRIE, TX 75050-8747
(214) 760-9573
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/03/2012
Last updated
05/03/2012
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