Individual
MR. TIMOTHY BRANDON FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRIMARY. BENEFICIARY
Contact information
Practice address
PO BOX 843835, DALLAS, TX 75284-3835
(214) 670-4624
Mailing address
841 FULLER AVE, CLEBURNE, TX 76031-7602
(682) 361-1750
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
TX
302R00000X
Health Maintenance Organization
Primary
—
TX
376J00000X
Homemaker
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177467101
—
TX
05
—
P00279651
—
TX
Enumeration date
01/17/2026
Last updated
03/14/2026
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