Healthcare Provider Details

I. General information

NPI: 1831979087
Provider Name (Legal Business Name): FULLER THEOLOGICAL SEMINARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E MISSOURI AVE STE 850
PHOENIX AZ
85014-2733
US

IV. Provider business mailing address

1110 E MISSOURI AVE STE 850
PHOENIX AZ
85014-2733
US

V. Phone/Fax

Practice location:
  • Phone: 602-613-1725
  • Fax:
Mailing address:
  • Phone: 602-613-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL LINGLE
Title or Position: CLINIC DIRECTOR
Credential: MFT
Phone: 602-613-1774