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General NPI Number Information
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NPI Number | 1316203029
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Entity Type | Organization
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Legal Business Name | FULLER LIFE INSTITUTE
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 4545 BISSONNET ST STE 289
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City | BELLAIRE
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State | TX
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Zip | 77401-3112
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Country | US
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Telephone | 855-245-5433
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Fax | 855-245-5433
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Provider Business Mailing Address
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Address Line | 4545 BISSONNET ST STE 289
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City | BELLAIRE
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State | TX
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Zip | 77401-3112
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Country | US
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Telephone | 855-245-5433
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Fax | 855-245-5433
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. AMY FULLER
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Credential | PHD, LMFT, LPC
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Telephone | 855-245-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201031
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License Number State | TX
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