Individual
MICHAEL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
777 SILVER OAK DR APT D117, CARSON CITY, NV 89706-1908
(775) 443-0138
Mailing address
PO BOX 272, CARSON CITY, NV 89702-0272
(775) 443-0138
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
NV
Enumeration date
07/30/2014
Last updated
07/30/2014
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