MEDICARE: STEWART EDWIN FULLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	80073	TX

General Provider Information

NPI Number	:	1558968040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEWART EDWIN FULLER

Provider Business Mailing Address
First Line	:	8751 COLLIN MCKINNEY PKWY STE 205
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1658
Country	:	US
Telephone Number	:	940-220-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	8751 COLLIN MCKINNEY PKWY STE 205
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1658
Country	:	US
Telephone Number	:	940-220-9307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/07/2020

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Directions to “ STEWART EDWIN FULLER ” Practice Location

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