Organization
CHERYL C. FULLER PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL C. FULLER PHD (PRESIDENT)
(817) 735-8222
Entity
Organization
Contact information
Practice address
1814 8TH AVE # B, FORT WORTH, TX 76110-1354
(817) 735-8222
(817) 924-1369
Mailing address
4320 BELLAIRE DR S APT 226W, FORT WORTH, TX 76109-5197
(817) 735-8222
(817) 924-1369
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2-3404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012JC
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/19/2006
Last updated
08/25/2010
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