Individual
ADAM K FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
191 OVERTHRUST RD, EVANSTON, WY 82930-9261
(435) 631-9918
Mailing address
235 HAYDEN AVE, EVANSTON, WY 82930-5606
(435) 631-9918
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
306
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118774100
—
WY
Enumeration date
02/20/2007
Last updated
03/29/2018
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