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Individual

DR. THOMAS CHARLES FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
2851 CHARLEVOIX DR SE STE 323, GRAND RAPIDS, MI 49546-7092
(616) 458-0692
(616) 458-8129
Mailing address
161 OTTAWA NW, STE 300C HUMAN RESOURCE ASSOCIATES, GRAND RAPIDS, MI 49503
(616) 458-0692
(616) 458-8129

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6301006879
MI
103T00000X
Psychologist
6301006879
MI
103TC0700X
Clinical Psychologist
Primary
6301006879
MI

Other

Enumeration date
06/07/2006
Last updated
10/18/2023
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