Individual
MATTHEW GERALD FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232-5428
(615) 936-2000
Mailing address
415 COUNTY ROAD 110 N, MOUND, MN 55364-8338
(386) 795-9322
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3369
MN
101YM0800X
Mental Health Counselor
Primary
6062
TN
101YM0800X
Mental Health Counselor
IMH18270
FL
Other
Enumeration date
05/03/2019
Last updated
07/02/2024
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