Individual
SAMUEL J FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
207 W GEORGIA AVE APT 202, NAMPA, ID 83686-3024
(307) 204-7560
Mailing address
4332 E THOMAS MILL DR, NAMPA, ID 83686-3020
(208) 461-1133
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7871077
ID
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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