Individual
MR. CLIFTON HENRY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LPC, LMFT
Contact information
Practice address
12951 HUEBNER RD, STE 781466, SAN ANTONIO, TX 78230-9998
(210) 970-1511
(210) 614-9911
Mailing address
12951 HUEBNER RD, STE 781466, SAN ANTONIO, TX 78230-9998
(210) 970-1511
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
#09189
TX
101YP2500X
Professional Counselor
9189
TX
1041C0700X
Clinical Social Worker
Primary
299
TX
106H00000X
Marriage & Family Therapist
1081
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
742637802
EMPLOYEE IDENTIFICATION #
TX
Enumeration date
08/16/2006
Last updated
08/28/2023
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