Individual
MR. BRIAN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LMSW, LMHP
Contact information
Practice address
500 WILLOW AVE, SUITE 305, COUNCIL BLUFFS, IA 51503-0827
(712) 256-4420
(712) 256-4423
Mailing address
500 WILLOW AVE, SUITE 305, COUNCIL BLUFFS, IA 51503-0827
(712) 256-4420
(712) 256-4423
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1978
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253517-00
—
NE
05
—
1010744
—
IA
Enumeration date
06/18/2007
Last updated
06/19/2008
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