Individual
MR. MICHAEL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHPS
Contact information
Practice address
3008 ROSS AVE STE 100, DALLAS, TX 75204-5519
(682) 277-9994
Mailing address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
(682) 277-9994
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
2076-0624
TX
Other
Enumeration date
09/30/2024
Last updated
04/14/2025
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