Individual
BURTON FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
5689 S REDWOOD RD, SUITE 30, SALT LAKE CITY, UT 84123-5447
(801) 268-1715
(801) 268-1783
Mailing address
5689 S REDWOOD RD, SUITE 30, SALT LAKE CITY, UT 84123-5447
(801) 268-1715
(801) 268-1783
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3785956004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3785956004
PROFESSIONAL LICENSE
UT
Enumeration date
10/03/2012
Last updated
10/03/2012
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