Organization
SOULFULLY URS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA ANTOINETTE FULLER LCSW, LCDC (CEO)
(206) 578-1207
Entity
Organization
Contact information
Practice address
9898 BISSONNET ST STE 470, HOUSTON, TX 77036-8280
(281) 888-6137
Mailing address
1918 WOODVALE DR UNIT B, MISSOURI CITY, TX 77489-1421
(281) 901-9412
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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