Individual
DR. JOHN REYNOLDS FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.ED.
Contact information
Practice address
VA MEDICAL CENTER (620), 1700 LINCOLN AVENUE, LEBANON, PA 17042-0000
(717) 272-6621
Mailing address
102 TIMBER VILLA, ELIZABETHTOWN, PA 17022-9223
(717) 367-1005
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS001071L
PA
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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