Individual
JEFF FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LSW
Contact information
Practice address
5110 CEDAR MILL LN, INDIANAPOLIS, IN 46237-8664
(317) 696-1626
Mailing address
5110 CEDAR MILL LN, INDIANAPOLIS, IN 46237-8664
(317) 696-1626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
33011463A
IN
Other
Enumeration date
01/21/2025
Last updated
01/21/2025
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