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Individual

NATHAN JAMES FULLMER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 228-7043
Mailing address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 228-7043

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-3902
ID

Other

Enumeration date
09/15/2008
Last updated
06/08/2023
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