Individual
MR. MICHAEL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHPS
Contact information
Practice address
6421 CAMP BOWIE BLVD STE 308, FORT WORTH, TX 76116-5421
(682) 277-9994
(833) 915-1751
Mailing address
6421 CAMP BOWIE BLVD STE 308, FORT WORTH, TX 76116-5421
(682) 277-9994
(833) 915-1751
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
2076-0624
TX
Other
Enumeration date
09/30/2024
Last updated
07/20/2026
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