Individual
SCOTT FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9616 PORTAGE RD, PORTAGE, MI 49002-7257
(269) 250-8200
Mailing address
1252 BANBURY RD, KALAMAZOO, MI 49001-4911
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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