Individual
MARY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2221 LEMA RD SE, RIO RANCHO, NM 87124-3963
(970) 433-2609
Mailing address
2221 LEMA RD SE, RIO RANCHO, NM 87124-3963
(970) 433-2609
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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