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Individual

MR. BRIAN JAY FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
1662 E CENTRE AVE, PORTAGE, MI 49002-4410
(269) 321-8564
Mailing address
5340 HOLIDAY TER, KALAMAZOO, MI 49009-2196
(269) 321-8564

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013172
MI

Other

Enumeration date
05/05/2006
Last updated
06/19/2012
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