Individual
MR. CHARLES ROBERT FULLER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-S
Contact information
Practice address
3201 UNIVERSITY DR E STE 150, BRYAN, TX 77802-3487
(979) 777-5545
Mailing address
1716 BRIARCREST DR STE 300, BRYAN, TX 77802-2777
(979) 431-5413
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
72142
TX
101YM0800X
Mental Health Counselor
72142
TX
101YP2500X
Professional Counselor
Primary
72142
TX
Other
Enumeration date
12/06/2016
Last updated
09/20/2023
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