Individual
FRED D FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMFT
Contact information
Practice address
3500 JFK PKWY STE 210, FORT COLLINS, CO 80525-2635
(970) 413-3406
(970) 372-1068
Mailing address
3500 JFK PKWY STE 210306E, FORT COLLINS, CO 80525-2635
(970) 413-3406
(970) 372-1068
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
160
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000149996
—
CO
Enumeration date
06/13/2016
Last updated
12/12/2017
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