Individual
JOHN PATRICK FULLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
725 MAIN ST, CARBONDALE, CO 81623-1936
(973) 714-3036
Mailing address
811 MAIN CT, CARBONDALE, CO 81623-1851
(973) 714-3036
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC.0016660
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC.0016660
STATE LICENSE
CO
Enumeration date
11/12/2020
Last updated
11/12/2020
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