Individual
MAKU MOANA MAREE FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAMFT
Contact information
Practice address
186 E 1800 N, LOGAN, UT 84341-2019
(435) 213-3062
Mailing address
1765 E 1500 N, LOGAN, UT 84341-2929
(435) 512-3305
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
13980508-3904
UT
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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