Healthcare Provider Details

I. General information

NPI: 1811820947
Provider Name (Legal Business Name): WILLIAM PRICE FULLMER IV LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILL FULLMER LAMFT

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N 400 E STE 102
NORTH LOGAN UT
84341-1960
US

IV. Provider business mailing address

480 SUNCREST LN APT 202
NORTH LOGAN UT
84341-3130
US

V. Phone/Fax

Practice location:
  • Phone: 435-754-9399
  • Fax:
Mailing address:
  • Phone: 435-764-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14286383-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: